Abstract
Breast cancer patients receiving adjuvant chemotherapy are at increased risk of acute care use. The incidence of emergency department (ED) visits and hospitalizations (H) have been characterized in other provinces but never in Alberta. We conducted a retrospective population-based cohort study using administrative data of women with stage I-III breast cancer receiving adjuvant chemotherapy. Rates of ED and H use in the 180 days following chemotherapy initiation were determined, and logistic regression was performed to identify risk factors. We found that 47% of women receiving adjuvant chemotherapy experienced ED or H, which compared favourably to other provinces. However, Alberta had the highest rate of febrile neutropenia-related ED visits, and among the highest chemotherapy-related ED visits. The incidence of acute care use increased over time, and there were significant institutional differences despite operating under a single provincial healthcare system. Our study demonstrates the need for systematic measurement and the importance of quality improvement programs to address this gap.
Highlights
Breast cancer is the most common cancer in Canadian women [1], with a significant proportion requiring chemotherapy for high-risk disease including those with nodepositive, triple-negative, or HER2-positive cancers
Receipt of adjuvant chemotherapy has been associated with higher incidence of acute care use [2,3], and rates are substantially higher in population data than reported in clinical trials [4]
The purpose of this study was to describe the frequency of emergency department (ED) and H for breast cancer patients receiving adjuvant chemotherapy in Alberta, and describe factors associated with these outcomes
Summary
Breast cancer is the most common cancer in Canadian women [1], with a significant proportion requiring chemotherapy for high-risk disease including those with nodepositive, triple-negative, or HER2-positive cancers. Receipt of adjuvant chemotherapy has been associated with higher incidence of acute care use [2,3], and rates are substantially higher in population data than reported in clinical trials [4]. A large Canadian study [5] evaluated rates of emergency department (ED) and hospitalizations (H) for breast cancer patients receiving adjuvant chemotherapy in four Canadian provinces: British Columbia, Manitoba, Ontario, and Nova Scotia. These metrics have never been reported for this province. The purpose of this study was to describe the frequency of ED and H for breast cancer patients receiving adjuvant chemotherapy in Alberta, and describe factors associated with these outcomes
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