Wilson Michelle, Mak Weng, Firth Melissa, Deva Sanjeev, Findlay Michael
Medical Oncology, Auckland City Hospital, Auckland.
Oncology, Faculty of Medical and Health Sciences, University of Auckland, Auckland.
N Z Med J. 2017 Aug 11;130(1460):63-72.
Thirty-day mortality has been proposed to be a useful indicator of avoidable harm to patients from systemic anticancer therapies (SACT). As a quality assurance tool, we assessed the 30-day mortality rate at Auckland City Hospital and compared this with international standards.
Clinical characteristics and treatment details of medical oncology patients who died within 30 days of SACT from October 2014-September 2015 were collected and compared with data from a similar series performed from October 2008-September 2009. SACT was limited to chemotherapy or biologic agents.
From October 2014-September 2015, 1,965 patients received 2,145 treatment regimens. Forty-seven patients (2.2%) died within 30 days of SACT. Treatment was given with palliative intent in 42 patients (in 89%) and curative intent in five (11%). Mortality rates did not change with time (2.8% in 2009 vs 2.2% in 2015). Of the patient who died within 30 days, ECOG performance status at the time of chemotherapy was one in 16 patients (34.0%), two in nine patients (19.1%) and 3/4 in nine of the 47 patients (19.1%). All patients treated with curative intent had a PS of 0 or 1. Most patients who died within 30 days were on first- or second-line therapy (45 and 38% respectively). Two-thirds of patients with a PS of 3/4 were receiving first-line therapy. Approximately half the patients died during their first cycle of therapy (48.9%).
Our local 30-day mortality data compares favourably to international benchmarks of 5% and has not increased over time. Performance of similar studies locally and nationally should be undertaken to continue to assess and improve the quality of our patient care.
30天死亡率被认为是系统性抗癌治疗（SACT）对患者造成可避免伤害的一个有用指标。作为一种质量保证工具，我们评估了奥克兰市医院的30天死亡率，并将其与国际标准进行比较。
收集了2014年10月至2015年9月期间在接受SACT后30天内死亡的肿瘤内科患者的临床特征和治疗细节，并与2008年10月至2009年9月期间进行的类似系列数据进行比较。SACT仅限于化疗或生物制剂。
2014年10月至2015年9月，1965例患者接受了2145个治疗方案。47例患者（2.2%）在接受SACT后30天内死亡。42例患者（89%）接受姑息性治疗，5例患者（11%）接受根治性治疗。死亡率未随时间变化（2009年为2.8%，2015年为2.2%）。在30天内死亡的患者中，化疗时的东部肿瘤协作组（ECOG）体能状态为1的有16例患者（34.0%），为2的有9例患者（19.1%），47例患者中有9例（19.1%）为3/4。所有接受根治性治疗的患者体能状态均为0或1。30天内死亡的大多数患者接受的是一线或二线治疗（分别为45%和38%）。体能状态为3/4的患者中有三分之二接受一线治疗。约一半患者在第一个治疗周期内死亡（48.9%）。
我们当地的30天死亡率数据优于5%的国际基准，且未随时间增加。应在本地和全国开展类似研究，以持续评估和改善我们的患者护理质量。
