Prince Rebecca M, Powis Melanie, Zer Alona, Atenafu Eshetu G, Krzyzanowska Monika K
Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Eur J Cancer Care (Engl). 2019 Jan;28(1):e12909. doi: 10.1111/ecc.12909. Epub 2018 Sep 20.
Emergency department visits and hospitalisations (ED+H) during systemic therapy are undesirable for both patients and the health system. We undertook a systematic literature review and meta-analysis to evaluate the frequency of unplanned all-cause and treatment-related ED+H among adults receiving adjuvant or palliative-intent systemic therapy for all cancers. Randomised controlled trials (RCT) and observational studies (OS) reporting ED+H were identified from Medline and EMBASE from inception to June 2016. Quality was assessed using modified STROBE, CONSORT or PRISMA guidelines, depending on study type. A total of 112 OS (308,662 patients) and 26 RCTs (16,081 patients) met inclusion criteria. Most articles focused on palliative treatment (59%) delivered as first-line, in breast, lung and colorectal cancers. Only 20 articles reported ED frequency. Treatment-related and all-cause hospitalisations were more common in routine practice than in RCTs (29% vs. 16% and 42% vs. 28% respectively); frequency varied by treatment intent and tumour site. Methodological issues were common, particularly poor definition of the at-risk period. Hospitalisations are common, especially in unselected populations, but few articles report this and do so poorly. Routine, standardised reporting of ED+H during chemotherapy should be included in RCT reports and evaluated in routine care following adoption of new treatments.
对于患者和卫生系统而言，全身治疗期间的急诊科就诊和住院（ED+H）都不理想。我们进行了一项系统的文献综述和荟萃分析，以评估接受辅助性或姑息性全身治疗的所有癌症成年患者中，非计划性全因和治疗相关的ED+H发生率。从Medline和EMBASE数据库建库至2016年6月，检索报告了ED+H的随机对照试验（RCT）和观察性研究（OS）。根据研究类型，使用修改后的STROBE、CONSORT或PRISMA指南评估质量。共有112项观察性研究（308,662例患者）和26项随机对照试验（16,081例患者）符合纳入标准。大多数文章关注的是作为一线治疗用于乳腺癌、肺癌和结直肠癌的姑息治疗（59%）。只有20篇文章报告了急诊科就诊频率。在常规实践中，与治疗相关的住院和全因住院比在随机对照试验中更常见（分别为29%对16%和42%对28%）；频率因治疗意图和肿瘤部位而异。方法学问题很常见，尤其是风险期定义不明确。住院很常见，特别是在未经过筛选的人群中，但很少有文章报告这一点，而且报告得也很差。随机对照试验报告中应纳入化疗期间ED+H的常规、标准化报告，并在采用新治疗方法后的常规护理中进行评估。
