***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To compare chemotherapy given at home with outpatient treatment in terms of  colorectal cancer patients ' safety , compliance , use of health services , quality of life , and satisfaction with treatment . Design : R and omised controlled trial . Setting : Large teaching hospital . Participants : 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer . Interventions : Treatment with fluorouracil ( with or without folinic acid or levamisole ) at outpatient clinic or at home . Main outcome measures : Treatment toxicity ; patients ' compliance with treatment , quality of life , satisfaction with care , and use of health re sources . Results : 42 patients were treated at outpatient clinic and 45 at home . The two groups were balanced in terms of age , sex , site of cancer , and disease stage . Treatment related toxicity was similar in the two groups ( difference 7 % ( 95 % confidence interval −12 % to 26 % ) ) , but there were more voluntary withdrawals from treatment in the outpatient group than in the home group ( 14 % v 2 % , difference 12 % ( 1 % to 24 % ) ) . There were no differences between groups in terms of quality of life scores during and after treatment . Levels of patient satisfaction were higher in the home treatment group , specifically with regard to information received and nursing care . There were no significant differences in use of health services . Conclusions : Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment . What is already known on this topic Home chemotherapy programmes have been proposed as an alternative to hospital treatment However , they are more costly , and there is little evidence on their impact on outcomes such as compliance , quality of life , or use of other health services What this study adds Home chemotherapy was not associated with an increased use of health services such as primary care or emergency departments Home chemotherapy had no effect on patients ' quality of life but increased their compliance with treatment and satisfaction , particularly with regard to nursing care Home chemotherapy seems an acceptable and safe alternative to outpatient treatment that may improve compliance with Background : Care closer to home is being explored as a means of improving patient experience as well as efficiency in terms of cost savings . Evidence that community cancer services improve care quality and /or generate cost savings is currently limited . A r and omised study was undertaken to compare delivery of cancer treatment in the hospital with two different community setting s. Methods : Ninety-seven patients being offered outpatient-based cancer treatment  were r and omised to treatment delivered in a hospital day unit , at the patient ’s home or in local general practice ( GP ) surgeries . The primary outcome was patient-perceived benefits , using the emotional function domain of the EORTC quality of life ( QOL ) QLQC30 question naire evaluated after 12 weeks . Secondary outcomes included additional QOL measures , patient satisfaction , safety and health economics . Results : There was no statistically significant QOL difference between treatment in the combined community locations relative to hospital ( difference of −7.2 , 95 % confidence interval : −19·5 to + 5·2 , P=0.25 ) . There was a significant difference between the two community locations in favour of home ( + 15·2 , 1·3 to 29·1 , P=0.033 ) . Hospital anxiety and depression scale scores were consistent with the primary outcome measure . There was no evidence that community treatment compromised patient safety and no significant difference between treatment arms in terms of overall costs or Quality Adjusted Life Year . Seventy-eight percent of patients expressed satisfaction with their treatment whatever their location , whereas 57 % of patients preferred future treatment to continue at the hospital , 81 % at GP surgeries and 90 % at home . Although initial pre-trial interviews revealed concerns among health-care professionals and some patients regarding community treatment , opinions were largely more favourable in post-trial interviews . Interpretation : Patient QOL favours delivering cancer treatment in the home rather than GP surgeries . Nevertheless , both community setting s were acceptable to and preferred by patients compared with hospital , were safe , with no detrimental impact on overall health-care costs OBJECTIVES To evaluate the feasibility and adherence to home delivery ( HD ) of pemetrexed maintenance treatment in patients with advanced non-squamous non-small cell lung cancer ( nsqNSCLC ) . MATERIAL S AND METHODS Exploratory , prospect i ve , single-arm , Phase II study in advanced nsqNSCLC patients , with an Eastern Cooperative Oncology Group ( ECOG ) performance status of 0/1 that did not progress after 4 first-line induction cycles of a platinum doublet .  The first cycle of pemetrexed ( 500mg/m(2 ) ) was hospital administered , further cycles were HD until progressive disease or discontinuation . Feasibility was assessed by the adherence rate to HD ( probability of reversion to hospital administration or treatment discontinuation due to HD ) as primary endpoint , and by health-related quality -of-life ( HRQoL : EQ-5D , lung cancer symptom scale [ LCSS ] ) , satisfaction with HD , overall survival ( OS ) , and safety . RESULTS 52 patients ( UK & Sweden ) received a median of 4 ( range 1 - 19 ) pemetrexed maintenance cycles . Adherence rate up to Cycle 6 was 98.0 % ( 95 % confidence interval [ CI ] : 86.4 % , 99.7 % ) . All but 2 patients remained on HD . 1 patient discontinued after Cycle 1 ( patient decision ) , and 1 after Cycle 6 ( non-compliance with oral dexamethasone ) . 87 % ( 33/38 ) of the patients preferred home to hospital treatment and in 90 % ( 28/31 ) of cases , physicians were satisfied with distant management of patients . During HD Cycles 2 - 4 mean change from baseline ranged from 3.0 to 7.7 for EQ-5D visual analog scale . The 6-month OS rate was 73 % ( 95 % CI : 58 % , 83 % ) . 1 patient had an HD-related adverse event ( device-related infection , Grade 2 ) and 1 patient died after Cycle 1 , before HD , due to a possibly drug-related atypical pneumonia . CONCLUSION HD of pemetrexed maintenance treatment in patients with advanced nsqNSCLC was feasible , safe , and preferred by patients , while maintaining HRQoL. Physicians were satisfied with distant patient management Although primary treatment for cancer has been associated with psychosocial distress , less research has focused on patients with advanced disease . Traditionally , the outcomes of treatment have been assessed using biomedical criteria , including tumour regression , progression and survival . It is argued that these data are inadequate to underst and the impact of cancer upon the patient . Instead , quality of life considerations are crucial when treatments are aversive , especially when the aims are palliative rather than curative . Fifty-three patients with advanced breast cancer or ovarian cancer were studied prospect ively for 6 months to assess whether the site and method of chemotherapy administration influenced their quality of life . Patients received palliative chemotherapy either at home or in hospital . Quality of life was operationalized as measurement of anxiety , depression , self-esteem , health locus of control , physical performance and symptoms . In addition , semi-structured interviews explored social roles , relationships , and perceptions of treatment . Hospital administered chemotherapy was perceived to be most distressing . Regression analysis indicated that anxiety and depression accounted for most of the variance in quality of life . Patients who died during the study 13 ( 24 % ) experienced considerable psychological and physical morbidity .  Women over 60 years , experienced less psychological and physical distress . Quality of life broadens the criteria by which cancer treatments are evaluated , to include the experience of the patient A prospect i ve comparative analysis of home and hospital comprehensive treatment for advanced non-ambulatory cancer patients was conducted . Patients were assigned to  hospital ( group A )  and home  ( group B ) treatment groups based on geographic location . Home treatment was provided by the Don Monti Home Oncology Medical Extension ( HOME ) program . A multidisciplinary health team , including an oncologist , oncology nurse , social worker , dietitian , and medical technologist , was transported to the home in a medically equipped van . Services included physical examinations , pain control , psychosocial interventions , chemotherapy and blood transfusions , nutrition consultation , and bereavement counseling .  One hundred seventy-four patients were treated at home and 44 in the hospital . Pretreatment characteristics were similar for both groups , with the exception that age under 50 years was more frequent in the hospital group , and home patients were more likely to have gastrointestinal ( GI ) cancer . Medical benefits for home treatment included decreased narcotic analgesic requirements , decreased hospitalization and length of stay , and improved measurements of fat stores for female patients . Improved survival for home patients was related to Karnofsky performance status , since there was no difference in survival for sicker patients with lower performance status whether they received home or hospital treatment . Patient and family acceptance of home treatment was excellent . Comprehensive home treatment provided by a multispecialty oncology team is an effective alternative to hospitalization for terminal cancer patients Context Hospital care for older people often means iatrogenic complications and a decline in function . Home hospital care might reduce these adverse outcomes . Content Patients were 65 years of age or older and required hospital care for pneumonia , heart failure , chronic obstructive pulmonary disease , or cellulitis . In phase I , they were hospitalized . In phase II , they could choose home hospital care ( continuous nursing care followed by at least daily visits from a nurse and a physician ) . Sixty percent of patients chose home hospital care . Patients who received this type of care had shorter stays ; fewer procedures , consultations , and indwelling devices ; less delirium ; greater satisfaction ; and similar functional outcomes . Caution s The study was nonr and omized , and data were missing . Conclusion Home hospital care may be a good alternative for selected patients . The Editors Although the acute care hospital is the st and ard venue for providing acute medical care , it is expensive and may be hazardous for older persons , who commonly experience  functional decline ,  iatrogenic illness  , and other adverse events during care ( 1 - 3 ) . Providing acute hospital-level care in a patient 's home is an alternative to hospital care ( 4 , 5 ) . Although several hospital-at-home models have been studied , there is controversy regarding the effectiveness of this method . In part , this reflects heterogeneity among hospital-at-home models ( 6 ) . A recent Cochrane review examined surgical and medical early hospital discharge models , terminal care , and admission avoidance , that is , substitutive models . Overall , no differences were found in health outcomes . Patients , but not caregivers , had increased satisfaction with hospital-at-home care , and there was some evidence that substitutive models may be cost-effective ( 7 ) . However , with some exceptions ( 8) , most of these models would be difficult to distinguish from augmented skilled nursing services , community-based long-term care , or home-based primary care services in the United States . In addition , most studies have been done in countries with single-payer national health insurance systems ( 7 - 14 ) . Previous research in the United States has been limited to a pilot study of a physician-led substitutive hospital-at-home model for older persons with acute medical illness ( 15 ) . The aim of our study was to evaluate the safety , efficacy , clinical and functional outcomes , patient and caregiver satisfaction , and costs of providing acute hospital-level care in a hospital at home that substituted entirely for admission to an acute care hospital for older persons . Methods Patients The target sample was community-dwelling persons , age 65 years and older , who lived in a catchment area and who , in the opinion of a physician not involved in the study , required admission to an acute care hospital for 1 of 4 target illnesses : community-acquired pneumonia , exacerbation of chronic heart failure , exacerbation of chronic obstructive pulmonary disease , or cellulitis . Patients were required to meet vali date d criteria of medical eligibility for hospital-at-home care ( 16 ) , which were design ed to identify patients who would be medically suitable for this type of treatment . The most common reasons for medical in eligibility were uncorrectable hypoxemia ( oxygen saturation < 90 % ) , suspected myocardial ischemia , and presence of an acute illness , other than the target illness , for which the patient was required to be hospitalized . Study Design This study was a prospect i ve quasi-experiment conducted in 2 consecutive 11-month phases . During the acute care hospital observation phase ( 1 November 1990 to 30 September 2001 ) , eligible patients were identified and followed through usual hospital care . Study coordinators verified the patient 's eligibility for hospital-at-home care using a st and ard protocol at the time of enrollment . During this observation phase of the study , most patients were identified the morning after admission . These patients made up the acute hospital observation comparison group . During the intervention phase ( 1 November 2001 to 30 September 2002 ) , eligible patients were identified at the time of admission and were offered the option of receiving their care in hospital at home rather than in the acute care hospital .  Patients who chose  hospital-at-home treatment were never admitted to the acute care hospital but received treatment , after initial evaluation ( usually in the emergency department ) , in their home . The intervention group comprised all patients eligible for hospital-at-home care  , irrespective of where they were treated . Approval The institutional review boards from each study site , the coordinating center , and officials at the Center for Health Plans and Providers at the Centers for Medicare & Medicaid Services ( CMS ) gave their approval for the study . All participants provided informed written consent . Study Sites The study was conducted in 3 Medicare managed care ( Medicare + Choice ) plans at 2 sites and at a Veterans Administration medical center . Univera Health and Independent Health , in Buffalo , New York , are Medicare + Choice plans that operate in an independent practice association model . These 2 plans collaborated to provide hospital-at-home care and made up 1 study site ( 
    Output:
    
Despite heterogeneity , majority of reported models for oncological home-hospitalization demonstrated that this is a safe , equivalent and acceptable alternative to ambulatory hospital care .