Home-based zoledronic acid infusion therapy in patients with solid tumours: compliance and patient–nurse satisfaction

This study aimed to explore patient and nurse satisfaction, compliance with best practice, technical feasibility and safety of home infusion of the bisphosphonate zoledronic acid (ZOL).

This was a prospective 1-year survey of home ZOL therapy (4 mg Zometa®, 15-min i.v., every 3–4 weeks) in patients with bone metastases secondary to a solid malignancy. A physician questionnaire, nurse satisfaction/feasibility questionnaire and patient satisfaction questionnaire were administered at several time-points.

Physician participation rate was 56.5 % (87/154). Physicians enrolled 818 patients visited by 381 predominantly community nurses. Of the 788 case report forms received, 763 met inclusion criteria. Patient characteristics were as follows: median age, 68 years (30–95); M/F, 40/60; ECOG-PS 0 or 1, 78.6 %;and primary tumour site, breast (55.2 %), prostate (28.4 %), lung (7.2 %) or other (9.4 %). Nurse satisfaction rates were high: organisation of home ZOL therapy, 90.9 %; ease of infusion, 96.7 %; patient–nurse relationship, 97.5 %; and relationship with hospital staff, 73 %. Patient satisfaction was also very high (95.3 %). The main reasons were quality of the nurse–patient relationship (57.6 %), less travel/waiting (68.8 %), home environment (52.9 %) and less disruption to daily routine (36.6 %). ZOL therapy was well tolerated, the discontinuation rate due to adverse events (including deaths whether related to diseases progression or not) was 33.6 %. The incidence of osteonecrosis of the jaw was 0.6 % and of fractures, 0.2 %. Practitioner compliance with best practice was 76.7–83.7 % for recommended and/or tolerated dosage, 73 % for dental hygiene checks at inclusion and 48–56 % thereafter, 66 % for pre-infusion hydration, and often undocumented for calcium/vitamin D supplementation.

Home ZOL therapy was well tolerated. Both patient and nurse satisfaction were very high. However, better compliance with best practice should be encouraged.