Transition to Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital


In a report published in the Journal of Oncology Practice, Keshvani et al found that transitioning from inpatient to outpatient ambulatory infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin)-based chemotherapy in patients with lymphoma at a safety net hospital was feasible. Moreover, the change resulted in reduced costs from drug acquisition and hospitalization. 

Study Details

To allow for 5 consecutive days of outpatient visits (at Parkland Memorial Hospital, Dallas), all outpatient treatments were started on Monday. On day 1, patients received an infusion of rituximab at the outpatient infusion center over 3 hours. On days 2 to 4, patients came for 1-hour appointments to receive etoposide, vincristine, and doxorubicin.

Morning doses of prednisone were administered in clinic, and patients were instructed to also take prednisone at night at home. After 96 hours of continuous infusion of etoposide, vincristine, and doxorubicin, patients returned to the infusion center on day 5 for a 1-hour infusion of cyclophosphamide.


From January 2017 through January 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. A total of 61 ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in hospital, 18 (69%) were the first cycle of treatment. Key findings were:

  • Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting.
  • Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy.
  • Per-cycle drug costs were 57.6% lower for outpatients due to differences in acquisition cost in the outpatient setting.
  • In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and avoided an estimated 336 days of hospital confinement.

The investigators concluded, “Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.”

Hsiao C. Li, MD, of the University of Texas Southwestern Medical Center, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: For full disclosures of the study authors, visit

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