Impacts on Health Outcomes and Resources Utilization of Hospital-at-home for Elderly Patients With Multiple Myeloma
Impacts on Health Outcomes and Resources Utilization of Hospital-at-home for Elderly Patients With Multiple Myeloma
The study aims to compare the overall survival adjusted to quality of life of 2 groups of
 patients with multiple myeloma, depending on the type of care: (1) day hospitalization
 exclusively or (2) day hospitalization combined with hospital-at-home.

 As secondary objectives, the study aims to compare the impacts of the two types of care
 organization on:

 -  the survival of patients and response to treatments according to criteria of the
 International Myeloma Working Group,

 -  psychological status of patients,

 -  specific toxicity related to treatment used (haematological and infectious toxicity,
 neurotoxicity, ...),

 -  health outcomes,

 -  the caregiver's burden,

 This study is combined with a qualitative study about the incentives and the barriers, and in
 order to set up the patient's typology.
Multiple myeloma, a malignant blood disease with about 5000 new cases diagnosed annually in
 France, essentially in the elderly population, is associated with alteration of quality of
 life resulting from pathology and therapies.

 Multiples cycles of chemotherapies are administered in a regular manner, as outpatient
 treatment or day hospitalization.

 In this study aiming to explore the impacts on health outcomes and resources utilization of
 hospital-at-home for elderly patients with multiple myeloma, all patients will be treated by
 4 standardized protocols of treatment including bortezomib by subcutaneous administration.

 9 centers will participate to the study. The study will not change the usual practices of
 care of these centers:

 -  6 centers organize patient care through day hospitalization combined with
 hospital-at-home,

 -  3 other centers rely exclusively on day hospitalization.

 The study will target overall the inclusion of 300 patients for the 9 centers and 70
 participants (35 for each arm: 10 patients, 10 caregivers, 15 from healthcare team) for the
 qualitative study.

 The individual follow up of each patient will last 12 months. The patient's vital status will
 be documented at the 24th month.
Inclusion Criteria:

 -  Patient > 65 years;

 -  Resident of the departments in Île-de-France region (75, 92, 93 and 94);

 -  Symptomatic multiple myeloma (relapsed or no);

 -  Patient planned to receive one of the following chemotherapy protocols including
 bortezomib (VELCADE®): VMP (Velcade, Melphalan, Prednisone), VCD (Velcade,
 Cyclophosphamide, Dexamethasone), VelDex (Velcade, Dexamethasone), VRD (Velcade,
 Revlimid, Dexamethasone);

 -  Ineligible for autologous hematopoietic stem-cell transplantation (ASCT);

 -  Covered by a health insurance;

 -  Patient who does not oppose to the use of his/her medical data for the purpose of
 clinical research.

 -  Adult patients under guardianship will can be enrolled in the study, a consent of
 tutor is needed completed by patient's consent.

 Exclusion Criteria:

 -  Resident of the departments of 77, 78 and 91 in Île-de-France region;

 -  Asymptomatic myeloma;

 -  Life expectancy < 6 months;

 -  Patient does not understand French language.