Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
Oncologist. 2011;16(3):378-87. doi: 10.1634/theoncologist.2010-0354. Epub 2011 Feb 24.
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.
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.
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.
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.
描述在社区癌症中心接受治疗的非选择性癌症患者群体中化疗相关住院治疗（CRH）的频率、性质、趋势、预测因素和结果，并探索在常规肿瘤学实践中实施持续质量改进方法的可行性。
我们对 2003 年 1 月至 2006 年 12 月在社区癌症中心接受化疗的连续成年癌症患者进行了前瞻性队列研究。通过病历摘录收集了人口统计学、合并症、诊断、治疗和实验室数据。住院治疗由多学科小组分类为与化疗相关或不相关。将经历 CRH 的患者与未经历 CRH 的患者进行比较。使用病例和对照的随机抽样子集，我们构建了一个逻辑回归模型来确定 CRH 的独立预测因素。
在 2068 名接受化疗的患者中，179 名（8.7%）经历了 262 次 CRH。大多数住院治疗与化疗无关（73.7%）。CRH 的月平均发生率为 1.5%，中位住院时间为 5 天，最常见的 CRH 类型是胃肠道（46.1%），其次是感染（31.4%），0.9%的化疗患者发生致命性 CRH。CRH 的显著预测因素包括合并症评分为 3-4 与 0，以及肌酐水平较高。
尽管绝大多数接受化疗的患者没有经历 CRH，但不幸的是，这些事件并非没有严重后果。在为患有多种合并症的患者提供化疗时应谨慎。系统地监测毒性可以直接导致改善护理质量。
