Hospitalisations and emergency department visits in cancer patients receiving systemic therapy: Systematic review and meta-analysis

Abstract

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.

Perspective of Oncology Patients During COVID-19 Pandemic: A Prospective Observational Study From India

“…2 Treatment-related morbidity is more common in the real-world setting than in the setting of randomized controlled trials. 3 Many oncology societies, such as ASCO and the European Society for Medical Oncology, have come up with guidelines on systemic chemotherapy during the SARS-CoV-2 pandemic. 4 , 5 The majority of them have suggested reducing unnecessary hospital visits, delaying chemotherapy in selected palliative settings, delaying surgery for low-grade or indolent disease, and switching to oral agents whenever applicable.…”

Trajectories of hospitalization in three groups of patients with incurable gastric cancer identified by hierarchical clustering: A retrospecitve analysis

“…Typically, QOL is evaluated using a questionnaire, and many studies that address changes in QOL are limited to speci c phases of the clinical course. However, hospitalization is considered a predictor of QOL [6]. This variable can be divided into planned and unplanned hospitalization, of which the latter is generally considered unfavorable for patients.…”

Remote Oncology Care: Review of Current Technology and Future Directions

“…Cancer is a leading cause of morbidity and mortality in the United States, with over 1.8 million new cancer diagnoses and more than 600,000 cancer deaths estimated for 2020 [ 1 ]. Furthermore, cancer care significantly impacts the overall healthcare system through high rates of emergency department utilization, hospital admission, and costly treatments whose toxicities have potential to diminish quality of life [ 2 - 4 ].…”

“…Less severe though far more prevalent toxicities such as nausea, vomiting, and diarrhea can have a large negative impact leading to volume depletion, metabolic and electrolyte imbalances and renal failure. Newer immunotherapies are associated with immune-related adverse events with unpredictable timing and vagueness of symptoms, making identification and management especially challenging [ 2 - 4 ].…”