Patterns of hospitalization and toxicity among patients undergoing cancer chemotherapy in community-based oncology practice in Brazil

Abstract

19678 Background: In Brazil, most cancer patients receive treatment outside the controlled clinical trial setting and at community- based clinics. In this scenario, data on treatment-related toxicity and its complications are seldom reported. Chemotherapy is frequently referred to as an excessively toxic treatment modality and this perception may have a negative impact on treatment decision-making. Methods: This is a single institution, prospective study. Eligible population consisted of all patients with solid tumors undergoing chemotherapy, between January/2005 and November/2006, at this community-based private oncology clinic with a multidisciplinary staff (physicians, nurses, pharmacists, nutrition and psycology experts). Treatment-related hospitalization (TRH) was defined as any hospitalization starting within 4 weeks after a chemotherapy session. Data concerning tumor-related symptoms and chemotherapy-induced toxicity were prospectively collected by a single physician. Results: A total of 59 patients were hospitalized during the study period. Median hospitalized patients′ age was 61 years and 58% were female. Most frequent tumor types were breast (36%), colorectal (14%), pancreatic (14%) and ovarian (9%) cancers. 34 (57%) of the 59 hospitalizations were classified as TRH. Febrile neutropenia (27%) and gastrointestinal complications (26%) were the main reasons for TRH. The median length of TRH was 4 days. 6/34 (17%) patients died during TRH: 5 died as a result of complications caused by disease progression (not chemotoxicity); 1 patient died as a consequence of chemotherapy-induced neutropenia and sepsis. TRH′s were associated to only 2% (34) of the 2203 chemotherapy sessions performed. Conclusions: Current evidence-based, consensus-guideline-oriented, cancer chemotherapy, administered by a multidisciplinary team of specialists, was associated to a low rate of treatment-related hospitalizations. Generally, chemotherapy-induced toxicity was reversible and manageable in the outpatient setting. The permanent monitoring and reporting of treatment-related toxicities is feasible in community-based clinical practice as part of a quality-assurance program. No significant financial relationships to disclose.