Aim: To evaluate the plausibility of home administration subcutaneous azacitidine for patients who prefer not to attend the centre due to personal reasons and/or compliance.
Background: Being a rural cancer treatment site where a significant portion of the patients live remotely from the treatment centre, some patients declined/stopped treatment due to travel. Enabling the patient to administer medication at home decreases travel and treatment times.
Azacitidine was selected as it is given as a subcutaneous injection and is relatively easy to be administered. This also usually requires 7 days of attendance each cycle.
Methods:
Identify potential patients and assess patient’s interest in self-administration. Training conducted as per protocol. Consent and an agreement to adhere to treatment instructions was signed. Prior to each cycle, the patient was reviewed by the haematologist. The azacitidine vials were collected by the patient together with a schedule with clear instructions from pharmacy.
Results: 6 out of 8 patients were deemed competent over the past five years. 2 were trained but failed competency/confidence test. 2 out of the 6 successful patients returned to the cancer centre for treatment due to cellulitis and another had no abdominal adipose tissue. An average of 12 hours travel time was saved for each patient per cycle. Treatment appointments of 210mins saved every cycle per patient.
Conclusion This option was not without issues (e.g. haematologist/s not referring patients; home storage conditions not checked by Oncology staff). This site also identified a group of patients (e.g. elderly/poor dexterity) who would have benefited from decreased travel times but were excluded from this trial. A bigger trial will be needed to be conducted with formalised policies and procedures in place. Ways to encompass more disadvantaged patients should also be considered. In summary, this seemed like a promising option for patients who live remotely.