International Health Program, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Aug;83(8):784-790. doi: 10.1097/JCMA.0000000000000298.
Cancer is one of the leading causes of death worldwide. Despite the rapid evolution of cancer treatment, chemotherapy remains the mainstay in the management of cancer. Chemotherapy can result in various adverse drug reactions (ADRs), which may lead to hospitalization and even life-threatening side-effects. Hematologic ADRs are among the most severe forms of ADR following chemotherapy, as they generally lead to hospitalization. It is important to realize the predictors and outcome of hematologic ADRs in cancer patients.
We conducted a hospital-based case-control study to include all the cancer patients who were hospitalized to receive chemotherapy in Taipei Veterans General Hospital during 2013. Among them the patients rehospitalized after chemotherapy due to neutropenia, leucopenia, or pancytopenia were identified as the study group. Control subjects consisted of hospitalized cancer patients who did not display the aforementioned ADRs. The study and control groups were numbered in the ratio of 1:4 and were age- and gender-matched. Their demographic and clinical characteristics were collected through chart review. Determinants of hematologic ADRs were then analyzed.
During the study period, we collected a total of 64 patients into the study group and 256 as control subjects. The mean length of hospitalization was 11 days in the study group of patients, which was 5 days longer than that in the control group (p < 0.001). Predictors of hematologic ADR-related hospitalization included history of hematologic ADRs, hypertension, cisplatin treatment, and a Charlson comorbidity score of 2 to 3.
Severe outcomes of hematologic ADRs may increase healthcare costs and decrease patient productivity. Therefore, the determinants of ADR-related hospitalization identified in this study may help improve the quality of healthcare for cancer patients.
癌症是全球主要死因之一。尽管癌症治疗迅速发展，化疗仍是癌症治疗的主要手段。化疗会导致各种药物不良反应（ADR），可能导致住院甚至危及生命的副作用。血液学 ADR 是化疗后最严重的 ADR 之一，因为它们通常会导致住院。了解癌症患者血液学 ADR 的预测因素和结果非常重要。
我们进行了一项基于医院的病例对照研究，纳入 2013 年在台北荣民总医院因化疗住院的所有癌症患者。其中，因中性粒细胞减少症、白细胞减少症或全血细胞减少症而再住院的患者被确定为研究组。对照组由未出现上述 ADR 的住院癌症患者组成。研究组和对照组按 1:4 的比例编号，并按年龄和性别匹配。通过病历回顾收集他们的人口统计学和临床特征。然后分析血液学 ADR 的决定因素。
在研究期间，我们共收集了 64 名患者进入研究组和 256 名作为对照组。研究组患者的平均住院时间为 11 天，比对照组长 5 天（p<0.001）。血液学 ADR 相关住院的预测因素包括血液学 ADR 病史、高血压、顺铂治疗和 Charlson 合并症评分 2-3。
血液学 ADR 的严重后果可能会增加医疗保健成本并降低患者的生产力。因此，本研究确定的与 ADR 相关的住院决定因素可能有助于提高癌症患者的医疗保健质量。
