LUXEMBOURG-In an effort to beat the skyrocketing costs of high-dose chemotherapy and transplantation, physicians at the Scripps Clinic, La Jolla, Calif, have launched a total outpatient therapy program that attempts to eliminate expensive hospital admissions.
"There is no question that high costs are a major impediment to the widespread use of transplantation," said Barry Meisenberg, MD, at the 7th International Symposium of the Multinational Association of Supportive Care in Cancer.
He emphasized that outpatient chemotherapy with stem-cell support, followed by prophylactic antibiotics and daily outpatient visits, can safely trim as much as 40% off bills that traditionally run between $100,000 and $150,000.
The Scripps Clinic approach was modeled after a program that originated at Duke University Medical School in 1992, but with several important differences, said Dr. Meisenberg, director of the Bone Marrow Transplant Program at Scripps.
Patients at Duke receive their high-dose chemotherapy as inpatients and are then discharged for outpatient supportive care. After employing this so-called subtotal outpatient strategy in 84 patients, Scripps oncologists inaugurated their total outpatient program, in which patients undergo high-dose chemotherapy and follow-up as outpatients.
To accomplish this, Dr. Meisenberg's group modified their chemotherapy regimens to exclude drugs that necessitate continuous bladder irrigation, hyperhy-dration, and hourly monitoring of fluid input and output. In addition, while Duke physicians combine bone marrow transplants with stem-cell reinfusion, the Scripps team uses peripheral blood stem cells only.
Finally, the Duke program has been limited to women with breast cancer treated with cisplatin(Drug information on cisplatin) (Platinol), cyclophosphamide(Drug information on cyclophosphamide) (Cytoxan, Neosar), and carmustine(Drug information on carmustine) (BiCNU), while Scripps has expanded the concept to include patients with other solid tumors, non-Hodgkin's lymphoma, and multiple myeloma, who undergo treatment with a variety of intensive regimens.