1 Dana-Farber Cancer Institute, Boston, MA.
2 Boston Children's Hospital, Boston, MA.
J Oncol Pract. 2019 Jan;15(1):e39-e45. doi: 10.1200/JOP.18.00319. Epub 2018 Dec 13.
The development of strategies to prevent or mitigate cancer treatment-related adverse events (AEs) is necessary to improve patient experience, safety, and cost containment. To develop a strategy to easily identify and mitigate AEs, we sought to understand the frequency and severity of those that resulted in hospitalizations.
We retrospectively characterized hospitalizations of ambulatory adult patients with solid tumor cancers within 30 days of chemotherapy administration using medical record data abstraction. Hospitalizations were categorized as caused by cancer symptoms, a noncancer medical condition, or a medical oncology treatment-related AE. Severity of the treatment-related AE hospitalization was rated using the National Patient Safety Agency risk assessment matrix scale.
Between May and October 2016, 116 patients experienced 197 hospitalizations (per-patient mean, 1.7 AEs; range, 1 to 7 AEs). Sixty-six percent (n = 130) of hospitalizations were related to cancer symptoms, whereas 19.3% (n = 38) were treatment-related AE hospitalizations. The median length of stay of hospitalizations that resulted from an AE was 6 days (interquartile range, 3 to 9 days), and 36.8% had more than 1 AE. GI symptoms accounted for 48.1% of AEs, and neutropenic fever accounted for 11.1%. Sixty-one percent of treatment-related AE hospitalizations were characterized as moderate severity.
Hospitalizations in patients with solid tumors as a direct result of their medical oncology care treatment are not uncommon. These findings argue for novel approaches, such as automated trigger tools, to identify and manage complications of medical oncology treatment before hospitalization is needed. Improved outpatient management of cancer symptoms may have a dramatic impact on hospitalizations for patients with cancer.
制定预防或减轻癌症治疗相关不良事件（AE）的策略是必要的，这有助于改善患者体验、安全性和成本控制。为了制定一种策略来轻松识别和减轻 AE，我们试图了解导致住院的 AE 的频率和严重程度。
我们使用病历数据摘录，回顾性地描述了 30 天内接受化疗的门诊成人实体瘤患者的住院情况。将住院归因于癌症症状、非癌症医疗状况或肿瘤内科治疗相关 AE。使用国家患者安全局风险评估矩阵量表对治疗相关 AE 住院的严重程度进行评分。
2016 年 5 月至 10 月期间，116 名患者经历了 197 次住院（每位患者平均 1.7 次 AE；范围为 1 至 7 次 AE）。66%（n=130）的住院与癌症症状有关，而 19.3%（n=38）是与治疗相关的 AE 住院。AE 导致的住院的中位住院时间为 6 天（四分位间距为 3 至 9 天），36.8%的患者有超过 1 次 AE。胃肠道症状占 AE 的 48.1%，中性粒细胞减少性发热占 11.1%。61%的治疗相关 AE 住院被归类为中度严重程度。
由于肿瘤内科治疗直接导致的实体瘤患者的住院并不少见。这些发现表明需要新的方法，如自动触发工具，以在需要住院治疗之前识别和管理肿瘤内科治疗的并发症。改善癌症症状的门诊管理可能会对癌症患者的住院产生巨大影响。
