The advent of FOLFOX and FOLFIRI as chemotherapy regimens for patients with unresectable, advanced, and recurrent colorectal cancer has not only improved life expectancy but has also made a significant contribution to quality of life by making outpatient treatment possible [7–9]. Continuous IV infusion of 5-FU is necessary to provide these treatments in an outpatient setting, therefore necessitating the use of a portable continuous infusion pump. However, some patients using infusion pumps report inconveniences in their daily lives during continuous administration while at home [10, 11]. To the best of our knowledge, this is the first report on patient preferences regarding portable disposable pumps for the continuous IV infusion of 5-FU at home.
In this study, patient surveys showed that overall satisfaction with the soft-shelled infusion pump was higher than it was with the hard-shelled infusion pump, with 65% of the patients indicating they would prefer to be treated with a soft-shelled pump. The reasons for this were that these pumps were easier to carry, had more convenient shapes and weights, and were less bulky than the hard-shelled type. These made them more comfortable for use during the day and while sleeping, meaning they were less obstructive to daily life. In a previous study on whether soft-shelled or hard-shelled devices for the at-home administration of antibiotics were preferred, 20/24 patients (83%) reported that they preferred soft-shelled devices [10], which agreed well with our results. On the other hand, many respondents preferred the hard-shelled pumps because they had scales on their sides that allows the patients to check how much liquid remained.
This study found a strong preference for soft-shelled infusion pumps, particularly among patients with BMIs of < 22 kg/m2. Patients with lower BMIs are generally lighter and have less fat and muscle mass than standard-weight individuals, potentially making them more sensitive to the shapes and weights of their pumps. This suggests that soft-shelled infusion pumps have lower levels of physical impact on patients. Of the 13 patients (65%) in this study who ultimately requested treatments with soft-shelled pumps, 10 were women. The reason women prefer soft-shelled pumps over men despite no significant differences in BMI levels may be that they feel the effects of the pump more than men, although this could not be verified in this study because of the small number of participants.
In our survey, the majority of the patients preferred soft-shelled infusion pumps over hard-shelled ones. Interestingly, however, more of the pharmacists who loaded the pumps preferred hard-shelled versions in terms of overall satisfaction. The reason for this was that the force applied to the syringe when mixing the medications was lighter than what was needed for the soft-shelled infusion pumps and that the scale made preparation easier because it could be checked as needed. We therefore found that soft-shelled infusion pumps were preferred by patients, whereas hard-shelled ones were preferred by the pharmacists who prepared them.
Healthcare professionals are aware of adverse events such as nausea, vomiting, anorexia, other gastrointestinal symptoms, and peripheral neuropathy while administering FOLFOX, FOLFIRI, and other therapies. Focusing on the quality of life after the pump is attached may also ease some of the treatment-related burdens on patients. It is presumed that in many facilities, physicians and pharmacists decide which portable continuous infusion pump to use based on convenience and cost; however, from the perspective of patient quality of life, the use of portable continuous infusion pumps that reflect patient preferences should also be considered. In particular, this study taught us that physicians and pharmacists, as members of the cancer chemotherapy team, should not only manage regimens, dosing schedules, and adverse events but also make every effort to improve the quality of life of their patients.
However, this study had several key limitations worth noting. First, the small sample size of infuser pumps available meant that only a small number of patients could be included. Second, only one questionnaire was completed for each infusion pump used, so repeated long-term assessments of quality of life were not possible. Third, the satisfaction rating was only assessed using the NRS. Future studies should consider these factors when focusing on the notable factors of BMI and the preferences of female patients.
This study revealed that more patients generally preferred soft-shelled infusion pumps over hard-shelled ones for delivering continuous colorectal cancer chemotherapy— particularly those patients with BMIs of < 22 kg/m2 and female patients. These results suggest that, in the future, the selection of portable continuous infusion pumps that consider patient preferences may also help to further improve patient quality of life.