Role of Adverse Events in Unscheduled Hospitalizations Among Patients With Solid Tumors Who Receive Medical Oncology Treatment

Abstract

PURPOSE: The development of strategies to prevent or mitigate cancer treatment–related adverse events (AEs) is necessary to improve patient experience, safety, and cost containment. To develop a strategy to easily identify and mitigate AEs, we sought to understand the frequency and severity of those that resulted in hospitalizations. METHODS: We retrospectively characterized hospitalizations of ambulatory adult patients with solid tumor cancers within 30 days of chemotherapy administration using medical record data abstraction. Hospitalizations were categorized as caused by cancer symptoms, a noncancer medical condition, or a medical oncology treatment-related AE. Severity of the treatment-related AE hospitalization was rated using the National Patient Safety Agency risk assessment matrix scale. RESULTS: Between May and October 2016, 116 patients experienced 197 hospitalizations (per-patient mean, 1.7 AEs; range, 1 to 7 AEs). Sixty-six percent (n = 130) of hospitalizations were related to cancer symptoms, whereas 19.3% (n = 38) were treatment-related AE hospitalizations. The median length of stay of hospitalizations that resulted from an AE was 6 days (interquartile range, 3 to 9 days), and 36.8% had more than 1 AE. GI symptoms accounted for 48.1% of AEs, and neutropenic fever accounted for 11.1%. Sixty-one percent of treatment-related AE hospitalizations were characterized as moderate severity. CONCLUSION: Hospitalizations in patients with solid tumors as a direct result of their medical oncology care treatment are not uncommon. These findings argue for novel approaches, such as automated trigger tools, to identify and manage complications of medical oncology treatment before hospitalization is needed. Improved outpatient management of cancer symptoms may have a dramatic impact on hospitalizations for patients with cancer.

The Randomized AMBORA Trial: Impact of Pharmacological/Pharmaceutical Care on Medication Safety and Patient-Reported Outcomes During Treatment With New Oral Anticancer Agents

“…The authors also emphasized that strategies are necessary to identify and manage complications of medical oncology treatment before hospitalization occurs. 24 Remarkably, patient-reported outcomes regarding treatment satisfaction (second primary end point) and satisfaction about information with medicines improved significantly because of the intensified clinical pharmacological/pharmaceutical care. Society published updated Chemotherapy Administration Safety Standards, which now include recommended standards for the use of oral antitumor agents 9,13 ; (2) A systematic review on interventions to improve oral chemotherapy safety and quality stated significant limitations for published data.…”

Indirect Treatment Comparison of Larotrectinib versus Entrectinib in Treating Patients with TRK Gene Fusion Cancers

“…As the clinical management of cancer improves, the impact of TRAEs is of increasing importance to healthcare stakeholders. Much of this is due to the impact of TRAEs on patients’ quality of life, compliance with clinical regimens, and the clinical and economic burden of illness [ 28 , 29 ]. For example, a recent retrospective analysis found that roughly 20% of unscheduled hospitalizations among patients with solid tumors were due to TRAEs [ 29 ].…”

“…Much of this is due to the impact of TRAEs on patients’ quality of life, compliance with clinical regimens, and the clinical and economic burden of illness [ 28 , 29 ]. For example, a recent retrospective analysis found that roughly 20% of unscheduled hospitalizations among patients with solid tumors were due to TRAEs [ 29 ]. Although interventions to identify and mitigate the impact of TRAEs can help address this challenge, these efforts may result in an increase in resource utilization that can increase the economic burden associated with the disease.…”

Verification of the Usefulness of an Assessment and Risk Control Sheet that Promotes Management of Cancer Drug Therapy

“…Since the 1990s have seen increasing attention to patient-reported outcomes, and the National Cancer Institute has developed the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) to enable patients to self-report their adverse events ( Basch et al, 2017 ). The PRO-CTCAE has been used to evaluate symptomatic toxicity in patients on cancer clinical trials ( Basch et al, 2016 ; Basch, 2017 ; Basch et al, 2017 ; Kawaguchi et al, 2017 ; Baratelli et al, 2019 ; Wong et al, 2019 ). One study has reported that a 5-month extension in the overall survival time by using the PRO-CTCAE ( Basch et al, 2017 ).…”