Abstract
Goal of work
This descriptive, retrospective study sought to identify the nature and magnitude of chemotherapy outpatients’ unplanned presentations and admissions to the emergency department and/or cancer centre at a large metropolitan tertiary hospital, and to explore the antecedents to those presentations.
Patients and methods
Retrospective data were collected for outpatients who made an unplanned presentation to a large metropolitan hospital in Sydney, Australia between October 1, 2006 and September 30, 2007. Detailed information was collected for those who had received cytotoxic chemotherapy at the hospital’s cancer centre within the 6 months prior to the unplanned presentation to hospital. Demographic and explanatory variables were identified, including: reasons for presentation, cancer diagnosis, chemotherapy regimens, and position in the chemotherapy trajectory.
Main results
The Cancer Institute NSW [27] figures indicate that each year approximately 518 outpatients are treated with chemotherapy at the participating cancer centre. During the study period, 316 cancer outpatients made 469 unplanned presentations to either the Cancer Centre or the hospital emergency department. Of those outpatients presented, 233 (73.7%) had received chemotherapy in the previous 6 months and made a total of 363 presentations. Of these 363 presentations, 253 (69.7%) occurred within 4 weeks of receiving chemotherapy. The majority of presentations by those who had received chemotherapy in the previous 6 months resulted in hospital admission (87.6%) for a median length of stay of 5 days. The most frequent presentation symptoms were nausea and/or vomiting (45.2%), pain (27%), fever and/or febrile neutropenia (23.4%), shortness of breath (19.3%), dehydration (12.1%), anaemia (8.8%), fatigue (8.8%), diarrhoea (8.8%), and anxiety and/or depression (5.5%).
Conclusions
Chemotherapy outpatients have significant unmet needs following treatment, indicating an urgent need for improved continuity of care and better integration of primary and tertiary health care services.
Similar content being viewed by others
References
Hassett MJ, O’Malley AJ, Pakes JR, Newhouse JP, Earle CC (2006) Frequency and cost of chemotherapy-related serious adverse effects in a population sample of women with breast cancer. J Natol Cancer Inst 98(16):1108–1117
National Health & Medical Research Council (NHMRC) (2003) Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown
Australian Institute of Health and Welfare (AIHW) (2008) Australian hospital statistics 2006-07, health services series no. 31. Cat. No. HSE 55, Canberra
Australian Institute of Health and Welfare (AIHW) (2007) Cancer in Australia: an overview, 2006, AIHW Cancer series no. 37. Cat. no. CAN 32, Canberra
Otto S (2001) Chemotherapy. In: Otto S (ed) Oncology nursing, 4th edn. Mosby, Sydney, p 638
Cooper C, Depledge J (2004) Cytotoxic chemotherapy: what do community nurses need to know? Br J Community Nurs 9(1):26–32
Jefford M, Baravelli C, Dudgeon P, Dabscheck A, Evans M, Moloney M, Scholfield P (2008) Tailored chemotherapy information faxed to General Practitioners improves confidence in managing adverse effects and satisfaction with shared care: results from a randomised controlled trial. J Clin Oncol 26(14):2272–2277
National Health and Hospitals Reform Commission (NHHRC) (2008) A healthier future for all Australians: interim report of the national health and hospitals reform commission. National Health and Hospitals Reform Commission, Canberra
Mitchell T (2007) The social and emotional toll of chemotherapy – patients’ perspectives. Eur J Cancer Care 16:39–44
Read H, Ladds S, Rhodes B, Brown D, Portlock J (2007) The Impact of a supplementary medication review and counseling service within the oncology outpatient setting. B J Cancer 96:744–75
Grunber SM, Dueson RR, Marros P, Geling O, Hansen M, Cruciani G, Daniele B, De Pouvourville G, Rubenstein EB, Daugaard G (2004) Incidence of chemotherapy-induced nausea and emesis after modern anti-emetics; perception versus reality. Cancer 100(10):2261–2268
Kris MG, Hesketh PJ, Herrstedt J, Rittenberg C, Einhorn LH, Grunber S, Koeller J, Olver I, Borjeson S, Ballatori E (2004) Consensus proposals for the prevention of acute and delayed vomiting and nausea following high-emetic-risk chemotherapy, Support Care Cancer [Online] 13(2) Available: http://dx.doi.org/10.1007/s00520-004-0699-x
Roscoe JA, Morrow GR, Hickok JT, Stern RM (2000) Nausea and vomiting remain a significant clinical problem: trends over time in controlling chemotherapy-induced nausea and vomiting in 1413 patients treated in community clinical practices. J Pain Symptom Manag 20(2):113–121
Apro M, Blower P (2005) 5-hydroxytryptamine type-3 receptor antagonists for chemotherapy-induced and radiotherapy-induced nausea and emesis: can we safely reduce the dose of administrative agents? Cancer 104(1):1–13
Pronzab P (2006) Cancer-related anaemia management in the 21st Century. Cancer Treat Rev 32:S1–S3
Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncol 5:353–360
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(1):155–163
Barsevick AM, Dudley W, Beck S, Sweeney C, Whitmer K, Nail L (2004) A randomised clinical trial of energy conservation for patients with cancer-related fatigue. Cancer 15(100):1302–1310
Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. doi:10.1093/annonc/mdn419
Schumacher KL, Koresawa S, West C, Hawkins C, Johnson C, Wais E, Dodd M, Paul SM, Tripathy D, Koo P, Miaskowski C (2002) Putting cancer pain management regimens into practice at home. J Pain Symptom Manag 23(5):369–382
Fortner BV, Ashley J, Chavez J (2003) Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manag 25(1):9–18
Chrisholm JC, Drommett D (2006) The evolution towards ambulatory and day-case management of febrile neutropenia. Br J Haematol 135:3–16
Padilla G, Ropka ME (2005) Quality of life and chemotherapy-induced neutropenia. Cancer Nurs 28(3):167–171
Sipas NV, Bodey GP, Kontoyiannis DP (2005) Perspectives for the management of febrile neutropenic patients with cancer in the 21st century. Cancer 103(6):1103–1113
Innes HE, Smith DB, O’Reilly SM, Clark PL, Kelly V, Marshall E (2003) Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomized controlled single centre study. Br J Cancer 89(1):43–49
Commonwealth Department of Health and Aging (2007) National Hospital Cost Data Collection: Cost Report Round 10 (2005-2006) AR-DRGv5.0, Commonwealth Department of Health and Aging, Canberra
Cancer Institute NSW (CINSW) (2006) Review of ambulatory/outpatient chemotherapy and haematology services in New South Wales 2005, Health Technology Analysts, NSW
McKenzie H, Boughton M, Hayes L, Forsyth S, Davies M, Underwood E et al (2007) A sense of security for cancer patients at home: the role of community nurses. Health Soc Care Community 15(4):352–9
Cancer Institute NSW (CINSW) (2007) A survey of Multidisciplinary Teams in New South Wales, Sydney
Cancer Nurses Society of Australia (CNSA) (2008) Position Statement for cancer coordinators, CNSA
Health V (2008) Linking cancer care: a guide for implementing coordinated cancer care. Metropolitan Health and Aged Care Services Division, Melbourne
McKenzie H, Hayes L, Forsyth S (2008) Explaining the complexities and value of nursing practice and knowledge. In: Crouch M, Morley I (eds) Illumination through critical prisms. Rodopi, Amsterdam
Molassiotis A, Brearley S, Saunders M, Craven O, Wardley A, Farrell C, Swindell R, Todd C, Luker K (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
McKenzie H, Boughton M, Hayes L, Forsyth S (2007) Struggling to articulate the value of its knowledge base: the crisis in contemporary nursing. In: Morley I (ed) The value of knowledge e-book. Inter-Disciplinary Press, Oxford
Smith J (2002) The changing face of community and district nursing. Aust Health Rev 25(3):131–133
Moore K, Johnson G, Fortner BV, Houts AC, Moore K, Johnson G, Fortner BV, Houts AC (2008) The AIM Higher Initiative: new procedures implemented for assessment, information, and management of chemotherapy toxicities in community oncology clinics. Clin J Oncol Nurs 12(2):229–38
Molassiotis A, Coventry PA, Stricker CT, Clements C, Eaby B, Velders L, Tittenberg C, Gralla RJ (2007) Validation and psychometric assessment of a short clinical scale to measure chemotherapy induced nausea and vomiting: the MASCC antiemesis tool. J Pain Symptom Manag 34(2):148–158
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McKenzie, H., Hayes, L., White, K. et al. Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Support Care Cancer 19, 963–969 (2011). https://doi.org/10.1007/s00520-010-0913-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-010-0913-y