University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI
University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
J Oncol Pract. 2016 Aug;12(8):e818-27. doi: 10.1200/JOP.2016.010959. Epub 2016 Jul 12.
Community oncology practices frequently manage chemotherapy-associated toxicities, which may disrupt treatment, impair quality of life, and induce unplanned service use. We sought to understand the patterns and correlates of unplanned health care service use among patients receiving first-cycle chemotherapy at five community-based ambulatory oncology practices.
A survey study examined the dichotomous outcome of unplanned service use, defined as oncologist visits, emergency department visits, and hospitalizations, resulting from toxicity-related factors. Newly diagnosed patients with breast, lung, head and neck, or colorectal cancer or non-Hodgkin lymphoma were recruited during the first chemotherapy cycle. Before beginning the second cycle of chemotherapy, patients completed a questionnaire that measured unplanned service use and overall distress, plus severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problems, pain, fever and chills, extremity edema, and dyspnea on a 5-point scale (1, did not experience; 5, disabling). Medical record reviews captured chemotherapy doses, comorbid conditions, and supportive care interventions. Mixed-effects logistic regression was used to identify factors associated with unplanned service use, with random effects specified for each clinic.
Among 106 patients (white, 98%; female, 74.5%; mean age ± standard deviation, 60 ± 11 years), frequently reported toxicities were pain, nausea, diarrhea, and constipation. Thirty-six patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported emergency department visits, and 8% reported hospitalizations. Factors significantly associated with unplanned service use were high patient-reported distress and receipt of colony-stimulating factor.
Service use resulting from toxicity-related factors occurs frequently in community oncology settings. Monitoring toxicity patterns and outcomes can inform proactive symptom management approaches to reduce toxicity burden between scheduled visits.
社区肿瘤学实践经常管理化疗相关毒性，这可能会中断治疗、损害生活质量并导致非计划性服务使用。我们旨在了解在五个社区门诊肿瘤学实践中接受第一周期化疗的患者中，非计划性医疗保健服务使用的模式和相关因素。
一项调查研究检查了因毒性相关因素导致的非计划性服务使用（定义为肿瘤科就诊、急诊就诊和住院）的二项结果。在接受第一周期化疗期间，招募了新诊断的乳腺癌、肺癌、头颈部癌或结直肠癌或非霍奇金淋巴瘤患者。在开始第二周期化疗之前，患者完成了一份问卷，该问卷衡量了非计划性服务使用和整体困扰，以及恶心、呕吐、腹泻、便秘、口腔溃疡、静脉导管问题、疼痛、发热和寒战、四肢水肿和呼吸困难的严重程度，采用 5 分制（1，未经历；5，致残）。病历回顾记录了化疗剂量、合并症和支持性护理干预措施。使用混合效应逻辑回归来确定与非计划性服务使用相关的因素，为每个诊所指定随机效应。
在 106 名患者（白人，98%；女性，74.5%；平均年龄±标准差，60±11 岁）中，经常报告的毒性是疼痛、恶心、腹泻和便秘。36 名患者（34%）报告了非计划性服务使用：29%报告了肿瘤科就诊，14%报告了急诊就诊，8%报告了住院治疗。与非计划性服务使用显著相关的因素是患者报告的高痛苦和接受集落刺激因子。
在社区肿瘤学环境中，因毒性相关因素导致的服务使用频繁发生。监测毒性模式和结果可以为在预约就诊之间提供积极的症状管理方法提供信息，以减轻毒性负担。
