Unplanned hospital presentations in oncology patients receiving chemotherapy: a secondary analysis of a randomized controlled trial to explore opportunities for improving supportive care.

PURPOSE: This study aimed to report the incidence, common reasons, and associated risk factors for unplanned hospital presentations during chemotherapy treatment.

METHODS

A secondary analysis using data from a randomized controlled trial containing hospital data for the first three cycles of chemotherapy of adult oncology patients in two tertiary hospitals in Australia. Descriptive statistics were used to report hospital utilization patterns. Poisson regression explored risk factors for unplanned presentations.

RESULTS

Analyses included data from 346 patients; 115 patients (33%) made one/or more presentations during the first three cycles of chemotherapy. Of 144 unplanned presentations, 74 (51%) were made during cycle 1. Predominant reasons were fever with/without neutropenia (n = 50, 35%) and nausea/vomiting (n = 30, 21%). Fifty-two percent (n = 75) of unplanned presentations did not result in hospital admission. Of 346 patients, 70 (20%) had hospital admissions with a median length of stay of 3 days (IQR 2-7). Multivariable analysis identified the following as predictors for unplanned presentations: cancer stage (stage 1 vs stage 4: IRR 2.50, 95% CI, 1.28-4.89; P = 0.01) and cancer type (lung cancer vs breast cancer: IRR 2.25, CI, 1.26-4.01; P = 0.01).

CONCLUSION

Nausea/vomiting management support may be one area warranting improvement, a frequent reason for unplanned presentations that are potentially preventable. Such support will be most beneficial during the first treatment cycle, when most unplanned presentations occurred. A high proportion of unplanned presentations did not result in hospital admission, indicating an opportunity to manage some of the side effects within primary care or outpatient settings, rather than utilizing emergency department services.