Presentation Description:
High Dose Methotrexate (HDMTX) is an integral part of osteosarcoma therapy whose main toxicities include myelosuppression, mucositis, nephrotoxicity, and hepatitis. In order to deliver HDMTX therapy safely, patients require urinary alkalinization, hydration, monitoring of renal function, therapeutic drug monitoring, and leucovorin rescue. Due to the required supportive care needs, HDMTX has historically been given as an inpatient. In some centers however, HDMTX is being given safely as an outpatient in order to reduce health care costs, improve patient quality of life and to deliver timely therapy with limited inpatient chemotherapy beds available.

At the time of this presentation, a pilot study was being undertaken at SickKids to: 1. determine the safety and feasibility of delivering HDMTX in an outpatient setting, 2. determine if there is an economic benefit in delivering HDMTX as an outpatient compared to as an inpatient, 3.  describe the outpatient MTX experience from the patient’s and parent’s perspective.

This aim of this presentation was to outline the processes and procedures that were necessary to set up ambulatory HDMTX. This project was truly a multidisciplinary undertaking, and would not have been possible without the knowledge and expertise of multiple health care providers. This presentationl reviewed how the outpatient program was set up within the Ontario Health Care context, as well as highlight lessons learned along the way.

Speakers:
Eleanor Hendershot, RN(EC), MN, BScN
Nurse Practitioner, Paediatric AfterCare Program
The Hospital for Sick Children, Toronto
Princess Margaret Cancer Centre, Toronto
Adjunct Lecturer, Lawrence S. Bloomberg Faculty of Nursing, Toronto

Sandra Ross, BA, RN
Clinical Support Nurse, Outpatient Day Hospital
Division of Hematology/Oncology
The Hospital for Sick Children, Toronto