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. 2019 Jul 1;5(7):1028-1035.
doi: 10.1001/jamaoncol.2019.0086.

Treatment-Related Complications of Systemic Therapy and Radiotherapy

Vikram Jairam  1 , Victor Lee  1 , Henry S Park  1   2 , Charles R Thomas Jr  3 , Edward R Melnick  4 , Cary P Gross  2   5 , Carolyn J Presley  6 , Kerin B Adelson  2   5   7 , James B Yu  1   2
Affiliations

Treatment-Related Complications of Systemic Therapy and Radiotherapy

Vikram Jairam et al. JAMA Oncol. .

Abstract

Importance: Systemic therapy and radiotherapy can be associated with acute complications that may require emergent care. However, there are limited data characterizing complications and the financial burden of cancer therapy that are treated in emergency departments (EDs) in the United States.

Objectives: To estimate the incidence of treatment-related complications of systemic therapy or radiotherapy, examine factors associated with inpatient admission, and investigate the overall financial burden.

Design, setting, and participants: A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample was performed. Between January 2006 and December 2015, there was a weighted total of 1.3 billion ED visits; of these, 1.5 million were related to a complication of systemic therapy or radiotherapy for cancer. Data analysis was conducted from February 22 to December 23, 2018. External cause of injury codes, Clinical Classifications Software, International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), Clinical Modification codes were used to identify patients with complications of systemic therapy or radiotherapy.

Main outcomes and measures: Patterns in treatment-related complications, patient- and hospital-related factors associated with inpatient admission, and median and total charges for treatment-related complications were the main outcomes.

Results: Of the 1.5 million ED visits included in the analysis, 53.2% of patients were female and mean age was 63.3 years. Treatment-related ED visits increased by a rate of 10.8% per year compared with 2.0% for overall ED visits. Among ED visits, 90.9% resulted in inpatient admission to the hospital and 4.9% resulted in death during hospitalization. Neutropenia (136 167 [8.9%]), sepsis (128 171 [8.4%]), and anemia (117 557 [7.7%]) were both the most common and costliest (neutropenia: $5.52 billion; sepsis: $11.21 billion; and anemia: $6.78 billion) complications diagnosed on presentation to EDs; sepsis (odds ratio [OR], 21.00; 95% CI, 14.61-30.20), pneumonia (OR, 9.73; 95% CI, 8.08-11.73), and acute kidney injury (OR, 9.60; 95% CI, 7.77-11.85) were associated with inpatient admission. Costs related to the top 10 most common complications totaled $38 billion and comprised 48% of the total financial burden of the study cohort.

Conclusions and relevance: Emergency department visits for complications of systemic therapy or radiotherapy increased at a 5.5-fold higher rate over 10 years compared with overall ED visits. Neutropenia, sepsis, and anemia appear to be the most common complications; sepsis, pneumonia, and acute kidney injury appear to be associated with the highest rates of inpatient admission. These complications suggest that significant charges are incurred on ED visits.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Park reported receiving personal fees from Varian Medical Systems Inc, and personal fees from RadOnc Questions LLC, outside the submitted work. Dr Gross reported receiving grants from NCCN/Pfizer and grants from Johnson & Johnson outside the submitted work. Dr Presley reported receiving grants from K12 CA133250 outside the submitted work. Dr Adelson reported receiving grants from Genentech, other support from Roche DIS, and other support from Huron Pharmaceuticals outside the submitted work. Dr Yu reported receiving grants from 21st Century Oncology and personal fees from Augmenix Inc, outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram of Inclusion Criteria for Study
CCS indicates Clinical Classifications Software; E-code, external cause of injury code; ED, emergency department; ICD-9, International Classification of Diseases, Ninth Revision, Clinical Modification; and ICD-10, International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification.
Figure 2.
Figure 2.. Treatment-Related Complications by Cancer Subtype
The 3 most frequent complications for the top 15 most common cancers are depicted in this graph.
See this image and copyright information in PMC

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