Outpatient chemotherapy, family-centered care, electronic information, and education in adolescents and young adults with osteosarcoma

Current osteosarcoma chemotherapy is "standard" (doxorubicin, cisplatin, high-dose methotrexate +/- ifosfamide-mesna, and etoposide +/- mifamurtide), but current regimens have many short-term, medium-term, and long-term side effects. Generally 12-15 cycles of chemotherapy are given in the hospital over 7-10 months. Even in the absence of new research protocols, improvement in quality of life is now possible, with all osteosarcoma chemotherapy agents now being able to be administered in the outpatient setting. Outpatient chemotherapy is not only less expensive, but in the adolescent and young adult population can result in better quality of life for some. In this paper, we share information to help reduce the frequency of hospitalization and review some tools and strategies to facilitate communication when providing outpatient chemotherapy, family-centered care, and information/education. These include antiemetics with both longer-acting 5HT antagonists and aprepitant, outpatient chemotherapy guidelines, and a 5-week editable calendar that is part of our electronic medical record. Sharing information on absolute lymphocyte count recovery is another means of maintaining hope and increasing understanding of the prognosis of osteosarcoma. Finally, this paper shares an advanced directive/palliative care "checklist" of issues for patients and caregivers to consider at end of life, ie, when "cure of cancer is not the answer". In summary, better communication at all stages of osteosarcoma care can help reduce hospitalization, improve quality of life, and maintain hope in the adolescent and young adult population with osteosarcoma.