Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, Connecticut.
JAMA Oncol. 2019 Jul 1;5(7):1028-1035. doi: 10.1001/jamaoncol.2019.0086.
Systemic therapy and radiotherapy can be associated with acute complications that may require emergent care. However, there are limited data characterizing complications and the financial burden of cancer therapy that are treated in emergency departments (EDs) in the United States.
To estimate the incidence of treatment-related complications of systemic therapy or radiotherapy, examine factors associated with inpatient admission, and investigate the overall financial burden.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample was performed. Between January 2006 and December 2015, there was a weighted total of 1.3 billion ED visits; of these, 1.5 million were related to a complication of systemic therapy or radiotherapy for cancer. Data analysis was conducted from February 22 to December 23, 2018. External cause of injury codes, Clinical Classifications Software, International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), Clinical Modification codes were used to identify patients with complications of systemic therapy or radiotherapy.
Patterns in treatment-related complications, patient- and hospital-related factors associated with inpatient admission, and median and total charges for treatment-related complications were the main outcomes.
Of the 1.5 million ED visits included in the analysis, 53.2% of patients were female and mean age was 63.3 years. Treatment-related ED visits increased by a rate of 10.8% per year compared with 2.0% for overall ED visits. Among ED visits, 90.9% resulted in inpatient admission to the hospital and 4.9% resulted in death during hospitalization. Neutropenia (136 167 [8.9%]), sepsis (128 171 [8.4%]), and anemia (117 557 [7.7%]) were both the most common and costliest (neutropenia: $5.52 billion; sepsis: $11.21 billion; and anemia: $6.78 billion) complications diagnosed on presentation to EDs; sepsis (odds ratio [OR], 21.00; 95% CI, 14.61-30.20), pneumonia (OR, 9.73; 95% CI, 8.08-11.73), and acute kidney injury (OR, 9.60; 95% CI, 7.77-11.85) were associated with inpatient admission. Costs related to the top 10 most common complications totaled $38 billion and comprised 48% of the total financial burden of the study cohort.
Emergency department visits for complications of systemic therapy or radiotherapy increased at a 5.5-fold higher rate over 10 years compared with overall ED visits. Neutropenia, sepsis, and anemia appear to be the most common complications; sepsis, pneumonia, and acute kidney injury appear to be associated with the highest rates of inpatient admission. These complications suggest that significant charges are incurred on ED visits.
全身治疗和放射治疗可能会引起急性并发症，这些并发症可能需要紧急护理。然而，在美国，关于在急诊部（ED）治疗的癌症治疗相关并发症以及其经济负担的描述性数据非常有限。
评估全身治疗或放射治疗相关并发症的发生率，分析与住院相关的因素，并研究整体经济负担。
设计、地点和参与者：对医疗保健成本和利用项目全国急诊部抽样进行了回顾性分析。2006 年 1 月至 2015 年 12 月期间，共有 13 亿次 ED 就诊，其中 150 万次与癌症全身治疗或放射治疗的并发症有关。数据分析于 2018 年 2 月 22 日至 12 月 23 日进行。使用外部伤害原因代码、临床分类软件、国际疾病分类第 9 版临床修订版、国际疾病分类第 10 版临床修订版和国际疾病分类、损伤和中毒的原因（ICD-10-CM）代码来识别与全身治疗或放射治疗相关的并发症患者。
治疗相关并发症的模式、与住院相关的患者和医院相关因素，以及治疗相关并发症的中位数和总费用是主要的结局。
在纳入分析的 150 万次 ED 就诊中，53.2%的患者为女性，平均年龄为 63.3 岁。与整体 ED 就诊相比，治疗相关 ED 就诊每年增加 10.8%，而整体 ED 就诊每年增加 2.0%。在 ED 就诊中，90.9%的患者住院，4.9%的患者在住院期间死亡。中性粒细胞减少症（136167[8.9%]）、脓毒症（128171[8.4%]）和贫血（117557[7.7%]）是最常见和最昂贵的（中性粒细胞减少症：55.2 亿美元；脓毒症：112.1 亿美元；贫血：67.8 亿美元）并发症，在 ED 就诊时就已被诊断出；脓毒症（比值比[OR]，21.00；95%CI，14.61-30.20）、肺炎（OR，9.73；95%CI，8.08-11.73）和急性肾损伤（OR，9.60；95%CI，7.77-11.85）与住院相关。排名前 10 位的最常见并发症的相关费用总计 380 亿美元，占研究队列总经济负担的 48%。
与全身治疗或放射治疗相关的 ED 就诊并发症在 10 年内的增长率是整体 ED 就诊的 5.5 倍。中性粒细胞减少症、脓毒症和贫血似乎是最常见的并发症；脓毒症、肺炎和急性肾损伤似乎与最高的住院率相关。这些并发症表明在 ED 就诊时会产生大量费用。
