Skip to main content

Advertisement

SpringerLink
Log in

Risk of unplanned visits for colorectal cancer outpatients receiving chemotherapy: a case-crossover study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Aim

This study was conducted to evaluate the impact of chemotherapy on the risk of unplanned visit in a cohort of colorectal cancer outpatients. Chief complaints for unplanned visits and risk factors for hospital admission were also analyzed.

Patients and methods

Clinical data of 229 consecutive colorectal cancer patients who were unexpectedly presented to our acute oncology clinic between 2006 and 2009 were reviewed. A case-crossover statistical analysis was applied to study the association between exposure to chemotherapy (trigger event) and the occurrence of unplanned visit (acute outcome) in three time windows (7, 15, and 21 days from the closest previous chemotherapy treatment). Cox model was used to assess the risk factors for hospitalization.

Results

There were 469 unplanned visits registered. Most of the patients had Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1 (80 %) and advanced cancer stage (78 %). The majority of unplanned visits (72 %) occurred within 30 days since last chemotherapy. The most frequent presenting complaints were pain, fatigue, and anorexia. The two time windows associated with higher risk of visit were 15 and 21 days from last treatment, both for early (odds ratio [OR] 3.8, CI 1.4–10.2 and OR 3.8, CI 1.4–10.2) and advanced disease stage (OR 1.71, CI 1–2.9 and OR 3, CI 1.5–5.9). Of the unplanned visits, 10 % resulted in hospital admission. Presenting with multiple symptoms and with deteriorated PS were both predictors for hospitalization.

Conclusion

Chemotherapy exposition triggers the need for unplanned visits over the second and third week after treatment. The prompt and effective management of unexpected events may be cost- and time-saving and reduce pressure on oncology services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Karim-Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW (2008) Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 44(10):1345–1389

    Article  PubMed  Google Scholar 

  2. De Angelis R, Grande E, Inghelmann R et al (2007) Cancer prevalence estimates in Italy from 1970 to 2010. Tumori 93:392–397

    PubMed  Google Scholar 

  3. Mayer DK, Travers D, Wyss A et al (2011) Why do patients with cancer visit Emergency Departments? Results of a 2008 population study in North Carolina. J Clin Oncol 29:2683–2688

    Article  PubMed Central  PubMed  Google Scholar 

  4. Diaz-Couselo FA, O’Connor JM, Nervo A et al (2004) Nonscheduled consultation in oncologic patients. How many of them are true emergencies? An observational prospective study. Support Care Cancer 12:274–277

    Article  CAS  PubMed  Google Scholar 

  5. Uramoto H, Iwashige A, Kagami S, Tsukada J (2005) Outpatient treatment for cancer patients at cancer chemotherapy centers in university hospitals. J UOEH 27:359–365

    PubMed  Google Scholar 

  6. Rubenstein EB (1998) Evaluating cost-effectiveness in outpatient management of medical complications in cancer patients. Curr Opin Oncol 10:279–301

    Article  Google Scholar 

  7. Hassett MJ, O’Malley AJ, Pakes JR et al (2006) Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. J Natl Cancer Inst 98:1108–1117

    Article  PubMed  Google Scholar 

  8. McKenzie H, Hayes L, White K et al (2011) Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Support Care Cancer 19:963–969

    Article  PubMed  Google Scholar 

  9. Dodd MJ, Miaskowski C, Paul S (2001) Symptoms clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 28:465–470

    CAS  PubMed  Google Scholar 

  10. Aprile G, Ramoni M, Keefe D, Sonis S (2009) Links between regimen-related toxicities in patients being treated for colorectal cancer. Curr Opin Support Palliat Care 3(1):50–54

    Article  PubMed  Google Scholar 

  11. Lau PM, Stewart K, Dooley M (2004) The ten most common adverse drug reactions (ADRs) in oncology patients: do they matter to you? Support Care Cancer 12:626–633

    PubMed  Google Scholar 

  12. Rothwell PM (2005) External validity of randomised controlled trials: “to whom do the results of this trial apply?”. Lancet 365(9453):82–93

    Article  PubMed  Google Scholar 

  13. Delea TE, Vera-Llonch M, Edelsberg JS et al (2002) The incidence and cost of hospitalization for 5-FU toxicity among medicare beneficiaries with metastatic colorectal cancer. Value Health 5:35–43

    Article  PubMed  Google Scholar 

  14. Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D (2002) Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 95:155–163

    Article  PubMed  Google Scholar 

  15. Kleeberg UR, Tews JT, Ruprecht T et al (2005) Patient satisfaction and quality of life in cancer outpatients: results of the PASQOC study. Support Care Cancer 13:303–310

    Article  CAS  PubMed  Google Scholar 

  16. Bang SM, Park SH, Kang HG et al (2005) Changes in quality of life during palliative chemotherapy for solid cancer. Support Care Cancer 13:515–521

    Article  PubMed  Google Scholar 

  17. Morrison V, Henderson BJ, Zinovieff F et al (2012) Common, important, and unmet needs of cancer outpatients. Eur J Oncol Nurs 16:115–123

    Article  CAS  PubMed  Google Scholar 

  18. Aprile G, Pisa FE, Follador A et al (2013) Unplanned presentations of cancer outpatients: a retrospective cohort study. Support Care Cancer 21:397–404

    Article  CAS  PubMed  Google Scholar 

  19. Maclure M (1991) The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 133:144–153

    CAS  PubMed  Google Scholar 

  20. Maclure M, Mittleman MA (2000) Should we use a case–crossover design? Annu Rev Public Health 21:193–221

    Article  CAS  PubMed  Google Scholar 

  21. Delaney JA (2009) The case crossover study design in pharmacoepidemiology. Stat Methods Med Res 18:53–65

    Article  PubMed  Google Scholar 

  22. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403

    Article  CAS  PubMed  Google Scholar 

  23. Song X, Zhao Z, Barber B, Gregory C, Schutt D, Gao S (2011) Characterizing medical care by disease phase in metastatic colorectal cancer. J Oncol Pract 7:25–30

    Article  Google Scholar 

  24. Vera-Llonch M, Weycker D, Glass A et al (2011) Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality. BMC Cancer 11:250

    Article  PubMed Central  PubMed  Google Scholar 

  25. Baena-Canada JM, Estalella-Mendoza S, Rosado-Varela P et al (2012) Use of health-care services during chemotherapy for breast cancer. Eur J Cancer 48:3328–3334

    Article  PubMed  Google Scholar 

  26. Bozdemir N, Eray O, Eken C et al (2009) Demographics, clinical presentations and outcomes of cancer patients admitted to the Emergency Department. Turk J Med Sci 39:235–240

    Google Scholar 

  27. De Andrea S, Montanari M, Moja L (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991

    Article  Google Scholar 

  28. Feyer P, Kleeberg UR, Steingraber M et al (2008) Frequency of side effects in outpatient cancer care and their influence on patient satisfaction—a prospective survey using the PASQOC® questionnaire. Support Care Cancer 16:567–575

    Article  PubMed  Google Scholar 

  29. Curt GA, Breitbart W, Cella D et al (2000) Impact of cancer–related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 5:353–360

    Article  CAS  PubMed  Google Scholar 

  30. Hofman M, Morrow GR, Roscoe JA et al (2004) Cancer patients’ expectations of experiencing treatment-related side effects: a University of Rochester Cancer Center-Community Clinical Oncology Program study of 938 patients from community practices. Cancer 101:180–185

    Article  Google Scholar 

  31. Aprile G, Ramoni M, Keefe D, Sonis S (2008) Application of distance matrices to define associations between acute toxicities in colorectal cancer patients receiving chemotherapy. Cancer 112(2):284–292

    Article  PubMed  Google Scholar 

  32. Barbera L, Atzema C, Sutradhar R et al (2013) Do patient-reported symptoms predict Emergency Department visits in cancer patients? A population-based analysis. Ann Emerg Med 61:427–437

    Article  PubMed  Google Scholar 

  33. Majem M, Galan M, Perez FJ et al (2007) The oncology acute toxicity unit (OATU): an outpatient facility for improving the management of chemotherapy toxicity. Clin Transl Oncol 9:784–789

    Article  CAS  PubMed  Google Scholar 

  34. Molassiotis A, Brearley S, Saunders M et al (2009) Effectiveness of a home care nursing program in the symptom management of patients with colorectal and breast cancer receiving oral chemotherapy: a randomized, controlled trial. J Clin Oncol 27:6191–6198

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The results of this study were partially presented at the 2013 MASCC Annual Meeting, Berlin, Germany.

Conflict of interest

The authors have no significant conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Oncology, University Hospital “S. Maria della Misericordia”, Udine, Italy

    Luisa Foltran, Giuseppe Aprile, Paola Ermacora, Nicoletta Pella, Emiliana Iaiza, Elena Poletto, Stefania Eufemia Lutrino, Micol Mazzer, Mariella Giovannoni, Giovanni Gerardo Cardellino, Fabio Puglisi & Gianpiero Fasola

  2. Department of Oncology, Hospital “S. Maria degli Angeli”, Pordenone, Italy

    Luisa Foltran

  3. Institute of Hygiene and Clinical Epidemiology, University Hospital “S. Maria della Misericordia”, Udine, Italy

    Federica Edith Pisa

  4. Hospice “Casa dei Gelsi,” ULSS 9, Treviso, Italy

    Micol Mazzer

  5. Dipartimento di Oncologia, Azienda Ospedaliera “S. Maria degli Angeli”, Via Montereale 24, 33170, Pordenone, Italy

    Luisa Foltran

Authors
  1. Luisa Foltran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Aprile
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica Edith Pisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paola Ermacora
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicoletta Pella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emiliana Iaiza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elena Poletto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefania Eufemia Lutrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Micol Mazzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mariella Giovannoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giovanni Gerardo Cardellino
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Fabio Puglisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gianpiero Fasola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luisa Foltran.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Foltran, L., Aprile, G., Pisa, F.E. et al. Risk of unplanned visits for colorectal cancer outpatients receiving chemotherapy: a case-crossover study. Support Care Cancer 22, 2527–2533 (2014). https://doi.org/10.1007/s00520-014-2234-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2234-z

Keywords

Search

Navigation