Foltran Luisa, Aprile Giuseppe, Pisa Federica Edith, Ermacora Paola, Pella Nicoletta, Iaiza Emiliana, Poletto Elena, Lutrino Stefania Eufemia, Mazzer Micol, Giovannoni Mariella, Cardellino Giovanni Gerardo, Puglisi Fabio, Fasola Gianpiero
Department of Oncology, University Hospital "S. Maria della Misericordia", Udine, Italy,
Support Care Cancer. 2014 Sep;22(9):2527-33. doi: 10.1007/s00520-014-2234-z. Epub 2014 Apr 13.
This study was conducted to evaluate the impact of chemotherapy on the risk of unplanned visit in a cohort of colorectal cancer outpatients. Chief complaints for unplanned visits and risk factors for hospital admission were also analyzed.
Clinical data of 229 consecutive colorectal cancer patients who were unexpectedly presented to our acute oncology clinic between 2006 and 2009 were reviewed. A case-crossover statistical analysis was applied to study the association between exposure to chemotherapy (trigger event) and the occurrence of unplanned visit (acute outcome) in three time windows (7, 15, and 21 days from the closest previous chemotherapy treatment). Cox model was used to assess the risk factors for hospitalization.
There were 469 unplanned visits registered. Most of the patients had Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 (80 %) and advanced cancer stage (78 %). The majority of unplanned visits (72 %) occurred within 30 days since last chemotherapy. The most frequent presenting complaints were pain, fatigue, and anorexia. The two time windows associated with higher risk of visit were 15 and 21 days from last treatment, both for early (odds ratio [OR] 3.8, CI 1.4-10.2 and OR 3.8, CI 1.4-10.2) and advanced disease stage (OR 1.71, CI 1-2.9 and OR 3, CI 1.5-5.9). Of the unplanned visits, 10 % resulted in hospital admission. Presenting with multiple symptoms and with deteriorated PS were both predictors for hospitalization.
Chemotherapy exposition triggers the need for unplanned visits over the second and third week after treatment. The prompt and effective management of unexpected events may be cost- and time-saving and reduce pressure on oncology services.
本研究旨在评估化疗对一组结直肠癌门诊患者非计划就诊风险的影响。同时分析非计划就诊的主要症状及住院风险因素。
回顾了2006年至2009年间连续229例意外前往我院急性肿瘤门诊的结直肠癌患者的临床资料。采用病例交叉统计分析方法，研究在三个时间窗（距上次化疗最近一次治疗后的7、15和21天）内化疗暴露（触发事件）与非计划就诊（急性结局）发生之间的关联。使用Cox模型评估住院风险因素。
共记录到469次非计划就诊。大多数患者东部肿瘤协作组体能状态（ECOG PS）为0 - 1（80%）且癌症分期较晚（78%）。大多数非计划就诊（72%）发生在末次化疗后30天内。最常见的症状为疼痛、乏力和厌食。与就诊风险较高相关的两个时间窗是距上次治疗15天和21天，早期（优势比[OR] 3.8，可信区间[CI] 1.4 - 10.2以及OR 3.8，CI 1.4 - 10.2）和晚期疾病阶段均如此（OR 1.71，CI 1 - 2.9以及OR 3，CI 1.5 - 5.9）。在非计划就诊患者中，10%导致住院。出现多种症状以及体能状态恶化均为住院的预测因素。
化疗暴露会引发治疗后第二周和第三周的非计划就诊需求。及时有效地处理意外事件可能节省成本和时间，并减轻肿瘤服务的压力。
