Costly Acute Care Episodes Are Common for Patients with Early Breast Cancer
?San Francisco, CA—Acute care utilization, namely, emergency department visits and hospitalizations, are surprisingly common among patients with early breast cancer, according to a retrospective study using an administrative database in Ontario, Canada.
The findings coincide with current efforts, at least in the United States, to reduce acute care utilization as a chief means of reducing the cost of treating cancer. In fact, keeping patients with cancer away from emergency departments and hospitals has become a quality measure in many healthcare systems.
“In clinical trial populations, serious adverse events resulting in hospitalization from adjuvant chemotherapy are uncommon, but in community populations there’s a lack of information regarding the frequency of these toxicities,” said Katherine A. Enright, MD, MPH, of the Carlo Fidani Peel Regional Cancer Centre in Mississauga, Ontario, who presented the study results at the 2012 Breast Cancer Symposium.
“The objective of this study was to identify the frequency and type of serious chemotherapy-associated toxicities resulting in acute care utilization among women undergoing contemporary adjuvant chemotherapy for early breast cancer, and to compare these rates to women with no history of cancer,” Dr Enright said.
More than 40% of Patients Seek Acute Care
The study identified 4718 patients who received at least 1 cycle of chemotherapy and who were matched to controls without cancer. The study did not include patients who had received growth factor support or dose-dense chemotherapy.
The majority (57.9%) of patients received docetaxel-containing chemotherapy regimens, and a smaller proportion received paclitaxel (21.9%) or anthracyclines only (20%).
An acute care contact (an emergency department visit or hospitalization) was noted if the visit occurred within 30 days of chemotherapy. At least 1 acute care visit occurred in 43% of the patients receiving adjuvant chemotherapy compared with 9% of the controls without cancer. In addition, 18% of patients receiving chemotherapy had multiple visits (range, 2-16) compared with 2% of the controls.
Hospital admissions were significantly more frequent (44%) in those with breast cancer compared with the controls (25%; P <.001).
Fever, neutropenia, and infection were the most frequent (24%) chemotherapy-associated toxicities; these events were more common with the use of docetaxel (28%) or with paclitaxel (20%) than with anthracycline-only chemotherapy regimens (16%).
“The use of taxane-based chemotherapy, a high comorbidity burden, and place of residence were all associated with increased odds of acute care utilization,” Dr Enright pointed out.
Krystyna D. Kiel, MD, Lecturer, Rush University Medical Center, Chicago, IL, commented that the findings are in line with those of a 2006 SEER (Surveillance, Epidemiology and End Results) database analysis. That analysis showed that 61% of patients with breast cancer receiving chemotherapy versus 42% of patients not receiving chemotherapy were seen in the emergency department or were hospitalized.
Dr Kiel found it noteworthy that 57% of the hospitalizations in the 2006 study were related to surgery for breast cancer. These episodes are very costly to the healthcare system, she indicated.
Dr Kiel said that the findings speak to the need for oncologists to choose treatment regimens based on efficacy, as well as on tolerability. For example, because taxanes were shown to be responsible for much of the toxicity leading to acute care utilization, their elimination might be appropriate in some patients, such as in patients with a low-risk disease, based on the Oncotype DX Recurrence Score.
Dr Kiel added, however, that the regimens currently recommended by the National Comprehensive Cancer Network (NCCN) all contain a taxane. “So, clinicians just have to anticipate these toxicities,” she said.