对接受早期乳腺癌辅助化疗的女性进行基于人群的急诊就诊和住院情况评估。

Population-based assessment of emergency room visits and hospitalizations among women receiving adjuvant chemotherapy for early breast cancer.

作者信息

Enright Katherine, Grunfeld Eva, Yun Lingsong, Moineddin Rahim, Ghannam Mohammad, Dent Susan, Eisen Andrea, Trudeau Maureen, Kaizer Leonard, Earle Craig, Krzyzanowska Monika K

机构信息

Trillium Health Partners-Credit Valley Hospital, Mississauga; Institute for Clinical Evaluative Sciences; Sunnybrook Odette Cancer Centre; Cancer Care Ontario; Princess Margaret Cancer Centre; University of Toronto; Ontario Institute for Cancer Research, Toronto; and Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada

出版信息

J Oncol Pract. 2015 Mar;11(2):126-32. doi: 10.1200/JOP.2014.001073. Epub 2015 Jan 20.

DOI:10.1200/JOP.2014.001073

PMID:25604597

Abstract

PURPOSE

Adjuvant chemotherapy is considered standard care for patients with lymph node (LN) -positive and high-risk LN-negative early breast cancer (EBC). Although chemotherapy-associated toxicities are documented in clinical trials, the impact of toxicities on emergency room (ER) visits and hospitalizations (ER + Hs) at a population level with contemporary chemotherapy is unknown. We undertook a population-based study of ER + Hs in patients with EBC receiving adjuvant chemotherapy compared with noncancer controls (NCCs).

METHODS

All patients diagnosed with EBC between January 2007 and December 2009 in Ontario, Canada, were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial health care databases to provide comprehensive medical follow-up. All patients received ≥ one cycle of adjuvant chemotherapy. Patient cases of EBC (n = 8,359) were matched to NCCs (n = 8,359) on age, comorbidity, and geographic location. ER + Hs within 30 days of chemotherapy were identified. If the primary reason for the visit was a common chemotherapy toxicity, the visit was considered chemotherapy associated. All-cause and chemotherapy-associated visits were compared between patient cases and controls. Logistic regression models were used to identify covariates associated with ER + Hs.

RESULTS

The proportion of patients with at least one ER + H was significantly higher in patients with EBC undergoing chemotherapy compared with NCCs (43.4% v 9.4%; P < .001). Patients with EBC were also more likely to have multiple ER + Hs (17.9% v 2.4%; P < .001). On multivariable analysis, comorbidity, receiving a regimen containing docetaxel, and certain geographic regions were associated with increased odds of ER + Hs.

CONCLUSION

ER + Hs are common among patients with EBC receiving chemotherapy and significantly higher than among controls. This represents a potential opportunity for quality improvement.

摘要

目的

辅助化疗被认为是淋巴结（LN）阳性和高危LN阴性早期乳腺癌（EBC）患者的标准治疗方法。尽管化疗相关毒性在临床试验中有记录，但在当代化疗的人群水平上，毒性对急诊室（ER）就诊和住院（ER+H）的影响尚不清楚。我们对接受辅助化疗的EBC患者与非癌症对照（NCC）进行了一项基于人群的ER+H研究。

方法

从安大略癌症登记处识别出2007年1月至2009年12月在加拿大安大略省被诊断为EBC的所有患者。患者记录通过确定性链接到省级医疗保健数据库，以提供全面的医疗随访。所有患者接受≥1周期的辅助化疗。EBC患者病例（n=8359）在年龄、合并症和地理位置上与NCC（n=8359）进行匹配。确定化疗后30天内的ER+H情况。如果就诊的主要原因是常见的化疗毒性，则该就诊被视为化疗相关。比较患者病例和对照之间的全因就诊和化疗相关就诊情况。使用逻辑回归模型识别与ER+H相关的协变量。