Thanks to scientific research in hematology, there has been a progressive improvement in therapeutic prospects. However, this scientific progress has placed other questions, namely the accessibility (at all levels) to care by patients and the increasingly of cost per year per patient.This context could lead to the paradoxical situation whereby patients, may not be able to benefit from it due to evident difficulties of various kinds (including logistics and costs). With these premises, the initiative we had activates is to bring life-saving chemotherapy to the home “sub cutaneous” or “per oral” so as to make it usable at home. By doing so we provides for the possibility of facilitating patients defined as “UNFIT” who have difficulty going to our hospital. Domiciliation of administration would improve patient compliance and adherence to chemotherapy. Our OBJECTIVE is guarantee the administration of chemotherapy at home to “UNFIT” patients in the ASP of Ragusa treated during 2022 activating two projects of home sub cutaneous or oral chemotherapy also reducing total costs per patient per year.

Materials and methods: During 2022 we provide identification of patients suffering from Myelodysplastic Syndrome, Multiple Myeloma, and Chronic Lymphatic Leukemia requiring chemotherapy and among these the number of patients defined as UNFIT.We activated two projects of home sub cutaneous or oral chemotherapy as follow:

PROJECT N° 1:DOMICILIATION OF CHEMOTHERAPY PER ORAL WITH OBLIGATION OF AIFA CARD for patients affected by Multiple Myeloma and Chronic lymphocytic leukemia

PROJECT N° 2: DOMICILIATION OF Sub Cutaneos CHEMOTHERAPY for patients affected by Multiple Myeloma in therapy with VELCADE;- Myelodysplastic syndrome in therapy with VIDAZA.

The following data shows the reports regarding the number of patients, the total number of chemotherapy treatments administered, the total amount of adverse events and the costs per year per patient of treatment in hospital compared to home treatment.

Results During 2022 we provide identification of patients who, despite requiring chemotherapy “sub cutaneous” or “per oral”, are defined as “UNFIT” according to international evaluation parameters.

We applied our two projects of domiciliation of chemotherapy as follow:

Project 1 provide domiciliation of chemotherapy per oral with obligation of aifa card and Project 2 that provide domiciliation of sub cutaneous chemotherapy.

The following data shows the reports regarding the number of patients, the total number of chemotherapy treatments administered, the percentage of adverse events and the costs of treatment in hospital compared to home treatment.

During Project 1 we treated 180 pts with per oral chemotherapy and among these, 20% (36 pts) defined UNFIT were enrolled in home therapy, and during Project 2 we treated 50 pts with sub cutaneous chemotherapy and among these, 20% (10 pts) were enrolled in home therapy.

The therapeutic adherence was of 100% for both projects and we didn't observe any adverse event in both projects. The total amount of administrations for UNFIT patients of Project 1 were 432 and the total amount of administrations for UNFIT patients of Project 2 were 660. The total cost for 12 months of treatment for UNFIT patients of Project 1 was 30,000 euros ( 34.690,10 $) instead 90.000 euros ( 104.094,45 $) for hospital-based treatment and the total cost for 12 months of treatment for UNFIT patients of Project 2 was 99.000 euros ( 114 588,22$) instead 180.000 euros (208.248,30 $)for hospital-based treatment.The patient satisfaction was 100% for both projects versus 50% compared patients treated in hospital.

Discussion The main objectives of the two projects include: reducing hospital admissions; providing home chemotherapy; ensuring the same quality of care for all; reduce the costs per patient per year and providing effective responses to clinical, healthcare, and psychological needs to improve quality of life. In the medium to long term, it is hoped that home chemotherapy will be available throughout the province. The path for the future is set to effectively respond to the ever-increasing needs of patients due to social and demographic changes. The Hematology Department of the Ragusa Local Health Authority intends to continue in this direction, as being treated at home is very different, psychologically and emotionally, from being treated in a hospital.

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2025
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