CLO19-043: Assessing the Risk of Chemotherapy Toxicity and Hospital Admission Due to Toxicity

Abstract

Background: Acute chemotherapy toxicity is common and can have negative effects for the patient and the health economy. Finding overall toxicity incidence for a typical teaching hospital population proved difficult, although a 2008 report into deaths within 30 days of chemotherapy found that 43% of patients who died reported a grade 3 or 4 toxicity (Mort D et al, available at: http://www.ncepod.org.uk/2008report3/Downloads/SACT_report.pdf). At Nottingham University Hospitals (NUH), a Cancer Admissions and Triage Team was established, who undertake a telephone assessment 24 hours following the administration of a first cycle of chemotherapy, in which a proactive toxicity assessment is completed. This had the aim of reducing hospital admission due to toxicity through timely advice and intervention and allowed the accrual of data regarding reported toxicity. Methods: Data was obtained from the telephone assessment of acute toxicity 24 hours after administration of a first cycle of chemotherapy, once the service had been in use for 1 year. Descriptive statistics were produced to establish toxicity incidence and severity and hospital admission rates as well as length of stay. Regression modelling was used to identify predictors of the 4 outcome measures. The commonest toxicities were explored as secondary outcome measures. Results: 1,539 patients were studied, and the overall incidence of toxicity was 35.6%. Disease site and number of chemotherapy agents given were shown to predict toxicity, with breast and upper gastrointestinal cancers having a higher likelihood of toxicity. The more anticancer agents used, the higher the risk of toxicity. Disease was predictive of toxicity grade, with urology, gynecology, and lung patients experiencing higher grades of toxicity than other tumor sites. The rate of hospital admission due to toxicity was 13.1% and mean length of stay 4.4 days. The risk of admission had some risk factors in common with toxicity. Disease and the number of drugs in the regimen affected the risk of admission, with gynecology, head and neck, and lung cancer patients and patients who received 3 drugs having a higher likelihood of admission. No predictors could be reliably identified for length of stay. Predictors in the subgroups of breast, lower gastrointestinal, and lung cancers did not differ greatly from the whole population, and the number of drugs was shown to be a predictor of nausea, vomiting, and fatigue when explored as secondary outcomes. Conclusion: Predictors were identified for occurrence of toxicity, severity of toxicity, risk of hospital admission, but not for length of stay. Subgroup analyses were undertaken. The overall burden of acute chemotherapy toxicity of a heterogeneous population was elucidated.