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. 2011;16(3):378-87.
doi: 10.1634/theoncologist.2010-0354. Epub 2011 Feb 24.

Chemotherapy-related hospitalization among community cancer center patients

Michael J Hassett  1 , Sowmya R Rao, Suzana Brozovic, James E Stahl, Joel H Schwartz, Betty Maloney, Joseph O Jacobson
Affiliations

Chemotherapy-related hospitalization among community cancer center patients

Michael J Hassett et al. Oncologist. 2011.

Abstract

Purpose: To describe the frequency, nature, trends, predictors, and outcomes of chemotherapy-related hospitalizations (CRHs) among a nonselected population of cancer patients treated at a community cancer center, and to explore the feasibility of implementing continuous quality improvement methodologies in routine oncology practice.

Methods: We conducted a prospective cohort study of consecutive adult cancer patients who received chemotherapy at a community cancer center January 2003 to December 2006. Demographic, comorbidity, diagnosis, treatment, and laboratory data were collected via medical record abstraction. Hospitalizations were classified as chemotherapy related or unrelated by a multidisciplinary panel. Patients who experienced CRHs were compared with those who did not. Using a randomly sampled subset of cases and controls, we built a logistic regression model to identify independent predictors of CRH.

Results: Of 2,068 chemotherapy recipients, 179 (8.7%) experienced 262 CRHs. Most hospitalizations were not chemotherapy related (73.7%). The mean monthly rate of CRH was 1.5%, the median length of stay was 5 days, the most common type of CRH was gastrointestinal (46.1%) followed by infectious (31.4%), and 0.9% of chemotherapy recipients had a fatal CRH. Significant predictors of CRH included having a comorbidity score of 3-4 versus 0 and having a higher creatinine level.

Conclusions: Although the vast majority of chemotherapy recipients did not experience a CRH, these events were, unfortunately, not without serious consequences. Care should be taken when offering chemotherapy to patients with multiple comorbid conditions. Systematic efforts to monitor toxicity can lead directly to improvements in quality of care.

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Conflict of interest statement

Disclosures

Michael J. Hassett: None; Sowmya R. Rao: None; Suzana Brozovic: None; James E. Stahl: None; Joel H. Schwartz: None; Betty Maloney: None; Joseph O. Jacobson: None.

Section Editor Eduardo Bruera discloses no financial relationships.

Section Editor Russell K. Portenoy discloses financial relationships with Cephalon, CNS Bio, Covidien Mallinckrodt Inc., Grupo Ferrer, Purdue Pharma, and Xenon; and research funding received by his institution from Ameritox, Archimedes Pharmaceuticals, Cephalon, Covidien Mallinckrodt Inc., Endo Pharmaceuticals, Forest Labs, GW Pharma, King Pharma, Meda Phamaceuticals, Ortho-McNeil Janssen Scientific Affairs LLD, Otsuka Pharma, Purdue Pharma, and Tempur-Pedic Corporation.

Reviewer “A” discloses a consulting/advisory relationship with Novartis and honoraria received from Novartis and Genentech. He further discloses that his spouse is employed with GlaxoSmithKline.

Reviewer “B” discloses no financial relationships.

The content of this article has been reviewed by independent peer reviewers to ensure it is balanced, objective, and free from commercial bias. On the basis of disclosed information, all conflicts of interest have been resolved.

Figures

Figure 1.
Figure 1.
Chemotherapy-related hospitalization rate over time. The monthly chemotherapy-related hospitalization rate, defined as the number of chemotherapy-related hospitalizations divided by the number of patients on active chemotherapy, remained relatively stable throughout the 4-year study.
Figure 2.
Figure 2.
Hospitalizations by cycle of chemotherapy. Shown are the total number of hospitalizations by the chemotherapy cycle number during which the hospitalizations occurred (left axis) and the percent of hospitalizations by chemotherapy cycle number (right axis). Although the exact number of patients eligible to receive each cycle of chemotherapy was not known, this number generally decreased as the cycle number increased.
See this image and copyright information in PMC

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