Evaluation of the Feasibility and Safety of Ifosfamide-Based Chemotherapy Regimens for Sarcomas in the Outpatient Setting

PURPOSE Ifosfamide is traditionally administered in an inpatient setting because of risks of neurotoxicity and hemorrhagic cystitis. To optimize quality of life while tackling the rising cancer care costs, organizations have been shifting chemotherapy administration to outpatient settings. This single-center, retrospective cohort study evaluated the safety and feasibility of administering ifosfamide-based chemotherapy regimens, MAI (mesna, doxorubicin, ifosfamide) and IE (ifosfamide, etoposide), in an outpatient service at a National Cancer Institute–designated Comprehensive Cancer Center. METHODS This single-center study included patients age 18-60 years treated between 2018 and 2024. Fifty-eight patients receiving MAI or IE were managed either through the outpatient service or in the inpatient setting. Clinical outcomes, including readmissions, urgent care visits, toxicities, and treatment completion, were compared. Hospital resource utilization was assessed by estimating average inpatient bed days saved. RESULTS The outpatient service saved an estimated 16.2 bed days per patient and 3.7 bed days per cycle. Clinical outcomes were comparable, with similar readmission (18.1% v 19.2%) and urgent care visit rates (5.5% v 4.8%), and no cases of hemorrhagic cystitis were reported. Grade ≥3 hematologic toxicities and treatment completion rates (>90%) were also similar across both arms. CONCLUSION These findings demonstrate that ifosfamide-based regimens through a structured outpatient model are both safe and reducing hospital resource utilization while maintaining treatment adherence and patient safety.