Authors (including presenting author) :
Mak WC(1), Wong NM (1), Leung WYC (1), Lee LH (1)
Affiliation :
Department of Clinical Oncology, QEH
Introduction :
Granulocyte-colony stimulating factor (G-CSF) is a growth factor that promotes blood cell proliferation & differentiation. It has been widely used in oncology settings to prevent infection & neutropenic fevers caused by chemotherapy. G-CSF can be administered by subcutaneous injection. However, daily subcutaneous injection requires regular GOPC visits & sometimes can be overwhelming for cancer patients. In the era of Covid-19 pandemic, social distancing & home care are especially imperative for immunocompromised cancer patients. To optimize the utilization of health care services & ease patients’ burden, QEH Chemotherapy Nurse Clinic has offered a G-CSF self-administration empowerment program for cancer patients.
Objectives :
To ease cancer patients/ their caregivers’ burden by minimizing GOPC visit & optimize health care services utilization
To understand patients’ experience of GCSF home administration & potential benefits of self-administration
Methodology :
Intervention: Education on G-CSF self-administraion
Patients/caregivers received education & training on self-administration of GCSF at nurse clinic. The education program includes four major aspects: education on medication storage, injection site selection, subcutaneous injection technique & care after injection. Patients or caregivers who are able to complete the training can administer GCSF at home.
Endpoint & outcome measures:
Endpoints were satisfaction with GCSF, effectiveness, safety, tolerability & compliance. Retrospective patient record analysis & patient survey with pre-set questionnaire was used to measure the stated outcomes.
Result & Outcome :
Characterization of patients:
In 2020, 64 patients/caregivers joined this program. Majority are female (92%, n=59), age range from 39-76 years-old (average age=57.5). Most patients inject the GCSF themselves (67.2%, n=43), others were injected by caregivers (31.3%, n=20).
Injection technique:
High self-administration successful rate 98.4% (n=63) was noted. Only one patient (1.56%) failed to inject the GCSF due to anxiety & needle phobia. None of the patient or caregiver required additional nurse consultation.
The tolerability & safety of GCSF:
None of the 64 patients experience adverse reactions or allergic reactions from GCSF, only one patient requested shorter duration of GCSF due to bone pain.
Effectiveness of GCSF:
Overall, low infection rate was noted. 3 events of febrile neutropenia occurred in 3 patients & no serious infections were observed.
Cost-effectiveness:
In terms of health care utilization in 2020, home administration of GCSF reduced 1823 GOPC visit.
Results of the survey:
20% of the cases (n=15) were evaluated for in-depth experience after GCSF home administration. All patients were able to store GCSF in 2-8℃, rotate injection site & none of them forgot to inject GCSF. All patient stated self-administration were easy & syringe was easy to use. Majority of patients (53.3%,n=8) revealed injections were very well tolerated. 93.3%(n=14) were very confident in GCSF self-administration. All patients opted they will continue to perform self-administration & all of them will recommend this program to other patients. Patients stated that this program can save waiting time in GOPC, convenience, reduce the chance of getting infections & reduce nurses’ workload.
Conclusion:
Patients found GCSF self-administration was easy & tolerable. During the pandemic, GCSF home administration eradicated the need to attend GOPC for regular injections bring economic benefits to both patients & healthcare system.
