P5-18-02: A Population Level Assessment of Emergency Room Visits and Hospitalizations for Women Undergoing Adjuvant Chemotherapy for Early Breast Cancer.

Abstract

Abstract Background: Adjuvant chemotherapy is considered the standard of care for women with lymph node positive and high risk lymph node negative breast cancer. While the acute toxicities of chemotherapy are well documented in clinical trials, the frequency of serious treatment related toxicities of adjuvant chemotherapy in the general population is not well described. We undertook a population based assessment of the frequency of serious treatment related toxicity in women undergoing adjuvant chemotherapy for early breast cancer (EBC). Methods: All incident EBC patients diagnosed between January 2007 and December 2008 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to multiple provincial administrative health care databases to provide comprehensive medical follow-up. Exclusion criteria were set to exclude patients on chemotherapy for advanced breast cancer. Any patient with who received at least 1 cycle of adjuvant chemotherapy was included in the analysis. Serious toxicities resulting in emergency room (ER) visits or hospitalizations occurring between the start date of chemotherapy and 30 days after the last dose of chemotherapy were identified. Logistic regression models were used to identify the impact of chemotherapy regimen, age, comorbidity and duration on therapy on the likelihood of experiencing serious toxicity. Results: Of the 3090 women identified in our cohort, 1440 (46.6%) experienced at least 1 serious toxicity resulting in an ER visit during their adjuvant treatment. Of the ER visits, the majority (1107, 87%) were attributable to treatment related toxicities. Febrile neutropenia (FN) was the most common treatment related toxicity occurring in 27.1% of patients in the cohort. Docetaxel containing regimens were associated with a significantly higher rate of ER visits and FN (54.6%, 34.6%) compared with paclitaxel (38.0%, 17.9%), or anthracycline alone (epirubicin 45.8%, 23.8%; doxorubicin 32.8%, 15.4%). Table 1 displays the impact of clinical and patient factors on multivariable analysis. Conclusion: Serious toxicities are a common in women undergoing adjuvant chemotherapy for EBC and result in significant acute health care utilization. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-18-02.