Toxicity-Related Factors Associated With Use of Services Among Community Oncology Patients

Abstract

QUESTION ASKED: What are the frequency and correlates of unplanned health care service use related to chemotherapy toxicities among patients receiving first-cycle chemotherapy at five community-based ambulatory oncology practices?SUMMARY ANSWER: Unplanned service use resulting from toxicity-related factors was reported by more than one-third of patients in this community oncology population, and 45% of patients reported at least one severe or disabling toxicity. Pain and nausea were most often rated severe or disabling (by 18% and 15% of patients, respectively) and were the top reasons for service use.WHAT WE DID: In this prospective survey study, newly diagnosed patients with breast, lung, head and neck, or colorectal cancer or non-Hodgkin lymphoma completed a questionnaire that measured unplanned service use and overall distress, plus severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problems, pain, fever and chills, extremity edema, and dyspnea on a 5-point scale (1, did not experience; 5, disabling).WHAT WE FOUND: Among 106 patients (white, 98%; female, 74.5%; mean age 6 standard deviation, 60 6 11), frequently reported toxicities were pain, nausea, diarrhea, and constipation, and 36 patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported emergency department visits, and 8% reported hospitalizations. In regression, factors significantly associated with unplanned service use were high patient-reported distress and receipt of colonystimulating factor, a proxy measure for intensity of the chemotherapy regimen. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:Limitations included recruitment of a convenience sample, exclusion of patients with previous cancer diagnoses, a predominantly white, non-Hispanic sample, and imbalanced participant sexes. The survey instrument did not detect source of pain. Survey responses may have been subject to recall bias. REAL-LIFE IMPLICATIONS:Our study addressed several issues critical to optimal delivery of patient care in community oncology settings, including the feasibility of toxicity reporting in a community oncology population and the relationship between toxicities and unplanned health care service use. With a 91% participation rate among eligible patients and a 100% survey completion rate among patients consenting to participate, this study demonstrated that brief patient surveys are a feasible method for systematic assessment of patient-reported toxicities and associated unplanned service use. Although severe toxicities warrant medical attention, routine use of symptom assessment tools can inform proactive symptom management approaches to reduce toxicity burden between scheduled visits. With further study of the most significant toxicities in a larger, more diverse sample of patients, strategies can be developed for implementation of clinical practice guidelines to improve management of toxicities in community oncology practices (Fig). Abstract PurposeCommunity oncology practices frequently manage chemoth...

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