Treatment-Related Complications of Chemotherapy and Radiation Therapy: An Analysis of the Nationwide Emergency Department Sample

Abstract

Chemotherapy and radiotherapy can be associated with adverse effects that are typically managed in the outpatient setting, but occasionally may require treatment in a hospital. However, there is limited data on the presentation of complications of cancer therapy in emergency departments (EDs) in the United States. We performed a retrospective analysis of the 2015 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. E-codes and International Classification of Diseases, Ninth Revision (ICD9) and Tenth Revision (ICD10) codes were used to identify patients with chemotherapy or radiation complications. Patient demographics, clinical, and hospital characteristics were examined. Multivariable logistic regression was used to identify predictors of inpatient mortality in our entire cohort as well as in individual chemotherapy and radiotherapy groups. Weighted frequencies were used for all data analysis. An estimated 219,918 ED visits occurred in 2015 due to complications of chemotherapy (82%) or radiotherapy (18%). The mean patient age was 63 and 54% were female. 88.8% were admitted to the hospital and 4.4% ultimately died. Factors predictive of increased mortality included age (odds ratio [OR] 1.02. 95% confidence interval [CI] = 1.01 – 1.02, P<0.001) and chemotherapy complication (OR 1.42, CI = 1.23 – 1.66, P<0.001). The most common cancers represented were lung cancer (11.6%), breast cancer (9.3%), and Non-Hodgkin’s Lymphoma (6.1%). Within our chemotherapy cohort, the most common complications were cytopenias (13.0%), sepsis (9.0%), and pneumonia (3.1%). Sepsis predicted for increased inpatient mortality (OR 2.74, CI = 2.11-3.58, P<0.001) compared to pneumonia. Within our radiotherapy cohort, the most common complications were cystitis (5.2%), proctitis (3.6%), and colitis (3.1%). Pneumonitis predicted for increased inpatient mortality (OR 15.0, CI = 3.31-68.1; P<0.001) compared to cystitis. The mean total charge for services was not significantly different between radiotherapy and chemotherapy patients ($61,876 vs $64,059; P=0.264). Increased age and adverse reaction to chemotherapy predicted for higher inpatient mortality amongst all patients presenting to the ED for complications of cancer therapy. Septicemia and pneumonitis predicted for increased inpatient mortality within our chemotherapy and radiotherapy cohorts, respectively. To our knowledge, this is the largest study to date to examine hospital presentations of cancer treatment-related complications.