Misery Loves Company: Presenting Symptom Clusters to Urgent Care by Patients Receiving Antineoplastic Therapy

Abstract

Uncontrolled symptoms are associated with unplanned acute care. Recognition of the complexity of symptom co-occurrence can drive improved management strategies.

Building a Clinically Relevant Risk Model: Predicting Risk of a Potentially Preventable Acute Care Visit for Patients Starting Antineoplastic Treatment

“…We defined a PPACV as a UCC visit for a potentially preventable symptom; a list of potentially preventable symptoms has been published and defined elsewhere as a symptom that could be managed safely in the outpatient setting if the clinical team identified said symptom early and managed it proactively. 19 A visit with any nonpreventable symptoms was labeled as negative. For example, if a patient presented with nausea (preventable) and a stroke (not preventable), the visit would not count as a PPACV.…”

“…Prior models have assessed risk in specific populations, such as geriatric oncology, [11][12][13] phase I trials, 14 advanced cancers, 15,16 and patients receiving chemoradiation, 17 or have predicted a specific complication, such as neutropenic fever, 18 and thus lack widespread applicability. Other models have predicted poor prognosis, 19 in-hospital mortality, 20 or all-cause hospitalizations 15,16,21 and thus have overlooked the opportunity to intervene meaningfully early in the course of a patient's treatment to prevent adverse outcomes. Although they effectively mine certain sociodemographics and clinical data, many of these models do not incorporate the wealth of information retrievable from the electronic medical record (EMR) through advances in machine learning.…”

Meeting the Challenge of Immune-Related Adverse Events With Optimized Telephone Triage and Dedicated Oncology Acute Care

“…Oncology HCPs are generally aware of the large management burden associated with cytotoxic chemotherapy for cancer. Patients undergoing chemotherapy experience an average of one hospital admission and two emergency department (ED) visits per year, and 40% to 50% of these visits are prompted by chemotherapy-related side effects ( Daly et al, 2018 ). Moreover, these visits come at a high cost and are primarily driven by reliance on acute hospital care, which accounts for roughly half (48%) of total cancer expenditures ( Brooks et al, 2014 ).…”

“…Moreover, these visits come at a high cost and are primarily driven by reliance on acute hospital care, which accounts for roughly half (48%) of total cancer expenditures ( Brooks et al, 2014 ). In 2010, the average cost of a chemotherapy-related hospitalization was $22,000 ( Daly et al, 2018 ). In addition to elevating health-care costs, an acute-care hospital visit delays treatment, reduces patients’ quality of life, adds to caregiver burden, and increases risk of nosocomial infections.…”

“…These are relatively common for chemotherapy-treated cancer patients; one retrospective study reported 43% within 90 days after chemotherapy infusion ( Aprile et al, 2013 ). Although not as well studied, unplanned presentations are likely to be even more common for patients treated with ICIs, and especially for those receiving combination therapy, where overlapping symptom (AE/irAE) clusters that are difficult to disentangle may predominate ( Daly et al, 2018 ). As has been noted, “The management of unscheduled presentations of cancer outpatients is becoming crucial to avoid inappropriate selection for hospital admission and interference with the ordinary work plan, improving quality of oncology services” ( Aprile et al, 2013 ).…”