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国立がん研究センター 中央病院

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Outpatient Treatment Center

Kenji Tamura, Hiroshi Nokihara, Hidehito Horinouchi, Shunsuke Kondo, Satoru Iwasa, Chitose Ogawa, Yasuji Miyakita, Natsuko Okita, Atsuko Kitano, Mayumi Tsukagoshi, Mihoko Asanabe, Hiroe Ohara, Akiko Takeda, Tomonobu Otsuka, Hironobu Hashimoto, Toru Akagi, Satoshi Nakajima

Introduction

The Outpatient Treatment Center deals with all kinds of cancer patients who have received chemotherapies. Our mission is to provide safe, comfortable and high-quality chemotherapies. Several groups collaborate to ensure the best chemotherapies, consisting of medical oncologists, nurses, pharmacists, medical social workers (MSW) and clinical research coordinators (CRCs). Our visions are 1) To provide evidence-based medicine (EBM), and development of novel anti-cancer drugs. 2) To provide safe and efficient treatments, and management of adverse events. 3) To create a comfortable environment, and to maintain the quality of life of the patients.

Routine activities

Setup

Our Division consists of one director (doctor), another 11 medical doctors, one nurse manager, two deputy nurse managers, one deputy drug director, one chief pharmacist, one dispensing chief, one chief engineer, Dept. Clinical Laboratory, 15 nurses, three pharmacists, and two to three reception staff.

Performance

We established a second Outpatient Treatment Center in the beginning of 2015. There are 30 beds in the first Outpatient Treatment Center and 26 in the second Outpatient Treatment Center (a total of 56). We also have six beds for general infusions or blood transfusions.
In 2015, the Outpatient Treatment Center supported 31,861 patients who received anticancer drugs (Table 1). The breakdown by department was Breast and Medical Oncology (n=11,997), Gastrointestinal Medical Oncology (n=6,928), Hepatobiliary and Pancreatic Oncology (n=3,642), Hematology (n=2,912), Thoracic Oncology (n=2,870), and other departments (n=3,733). Clinical trials for unapproved drugs increased to around 240 cases per month. General infusions, general intramuscular or subcutaneous injections, blood transfusions, bone marrow puncture, lumbar puncture, intraperitoneal or chest drainage, and blood gas analyses were conducted in the center.

Staff meeting

The monthly staff meeting is held on the second Tuesday, 16:30-17:30, every month with the participation of physicians and nurses who are main members of the center. The steering committee is held on the third Thursday of every month.

Hot line and conference

We have a telephone consultation service (Hot line) for outpatients who have received chemotherapies. A case conference dedicated to the Hot line is held monthly on a Tuesday with the participation of multidisciplinary specialists, including medical oncologists, nurses, and pharmacists.

Research activities

  • Treatment of platinum-containing regime in outpatient style.
  • Efficacy of frozen globe against nail toxicities by docetaxel.
  • Protection of allergic reaction by Oxaliplatin in outpatients.
  • Management of skin toxicities as an adverse event of molecular-targeted drugs.
  • Cosmetic support for female cancer patients
  • Support for continuing working for outpatients.
  • Telephone hot line for emergencies for out-patients who receive chemotherapy.
  • Monitoring adverse events of immuno checkpoint inhibitors.

Publication

  1. Kondo S, Shiba S, Udagawa R, Ryushima Y, Yano M, Uehara T, Asanabe M, Tamura K, Hashimoto J. Assessment of adverse events via a telephone consultation service for cancer patients receiving ambulatory chemotherapy. BMC Res Notes. BMC Res Notes. 2015 Jul 26; 8:315. doi:

Education

We provide educational opportunities for multidisciplinary specialists, including medical oncologists, nurses, and pharmacists. We also provide an educational program directed outside the hospital for medical oncologists, nurses, pharmacists and MSW in specially designed hospitals for cancer treatment in each prefecture.

Future prospects

We are planning to undertake more activities in the second Outpatient Treatment Center, and continue to propose a model for more clinical trials in an outpatient style. We aim to shorten waiting times, undertake the smooth administration of novel molecular targeted drugs for outpatients, put into practice multidisciplinary care, and create a comfortable environment for cancer patients who received chemotherapy in the Outpatient Treatment Center.


Table 1. Cumulative total number of patients who received anticancer drug by intravenous administration

 

Figure 1. Total number of patients who received chemotherapy in Outpatients Treatment Center

Figure 1. Total number of patients who received chemotherapy in Outpatients Treatment Center

 

Figure 2. Proportion of cancer types in patients who received chemotherapy in Outpatients Treatment Center

Figure 2. Proportion of cancer types in patients who received chemotherapy in Outpatients Treatment Center

List of papers published in 2015

Journal

  1. Kondo S, Shiba S, Udagawa R, Ryushima Y, Yano M, Uehara T, Asanabe M, Tamura K, Hashimoto J. Assessment of adverse events via a telephone consultation service for cancer patients receiving ambulatory chemotherapy. BMC Res Notes, 8:315, 2015