Early Discharge and Outpatient Care After Chemotherapy in Patients With Myelodysplastic Syndrome or Acute Myeloid Leukemia
Early Discharge and Outpatient Care After Chemotherapy in Patients With Myelodysplastic Syndrome or Acute Myeloid Leukemia
RATIONALE: Gathering information about patients with myelodysplastic syndrome or acute
 myeloid leukemia who are discharged after finishing chemotherapy, or who stay in the hospital
 until blood counts return to normal, may help doctors learn more about a patient's quality of
 life, use of medical services, and the cost of these services.

 PURPOSE: This clinical trial is studying early discharge and outpatient care in patients who
 have undergone chemotherapy for myelodysplastic syndrome or acute myeloid leukemia.
OBJECTIVES:

 Primary

 -  To compare the death rate in patients with myelodysplastic syndromes or acute myeloid
 leukemia who are discharged after completion of induction chemotherapy vs those who
 remain in the hospital until blood counts recover.

 Secondary

 -  To determine the proportion of patients who meet the early discharge criteria after
 completion of induction chemotherapy.

 -  To compare the costs incurred by patients who are discharged early vs those who are
 discharged only after blood counts recover.

 -  To compare resource utilization (e.g., transfusions) among these patients.

 -  To compare the quality of life of these patients.

 OUTLINE: Within 72 hours after completion of induction chemotherapy, patients are either
 discharged from the hospital or remain in the hospital until their blood counts recover.

 Patients receive standard supportive care after completion of induction chemotherapy either
 in the hospital or as an outpatient. Outpatients are seen by a registered nurse or physician
 assistant ≥ 3 times weekly and by a physician at least once weekly.

 A medical chart review is conducted to obtain information about medical complications (e.g.,
 neutropenic fever, documented infections, bleeding, reasons for hospitalization) and use of
 medical resources. Patients complete the MDA Symptom Inventory and the EORTC QLQ-C30
 questionnaire periodically to assess quality of life. Costs associated with inpatient and
 outpatient care are evaluated using electronic billing information from the University of
 Washington Medical Center and Seattle Cancer Care Alliance.

 After completion of the study, patients are followed up for 1 month.
DISEASE CHARACTERISTICS:

 -  Diagnosis of one of the following:

 -  Myelodysplastic syndromes

 -  Acute myeloid leukemia (AML)

 -  No acute promyelocytic leukemia with t(15;17)(q22;q12), PML/RAR, or other
 variants

 -  Planning to undergo AML-like intensive induction chemotherapy (e.g., "7+3" or regimen
 with similar or higher intensity) for untreated or relapsed disease within 1 week
 after study entry OR has started therapy within the past 72 hours

 PATIENT CHARACTERISTICS:

 -  No hypersensitivity or allergy to fluoroquinolones, triazoles, or acyclovir

 -  ECOG/WHO/ZUBROD performance status 0-1*

 -  Total bilirubin ≤ 2.5 times upper limit of normal (ULN) (unless elevation is thought
 to be due to Gilbert's syndrome or hemolysis)*

 -  AST and ALT ≤ 1.5 times ULN*

 -  Serum creatinine ≤ 1.5 times ULN*

 -  No clinical evidence of congestive heart failure*

 -  No active bleeding*

 -  Not refractory to platelet transfusions (e.g., due to HLA-alloimmunization)*

 -  No requirement for IV antimicrobial therapy*

 -  Agrees to undergo close follow-up that includes ≥ 3 visits per week at the Seattle
 Cancer Care Alliance (SCCA)*

 -  Has a confirmed reliable caregiver and transportation*

 -  Confirmed temporary or permanent residency within a 30-minute commute from the
 University of Washington (UW) Medical Center/SCCA*

 -  Has identified a UW/SCCA hematologist/oncologist who is willing to care for the
 patient in the outpatient clinic* NOTE: *Additional criteria for early discharge from
 the hospital

 PRIOR CONCURRENT THERAPY:

 -  See Disease Characteristics