• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Unplanned Hospital Visits During Radiation Therapy

 
Measure Desired Direction As of this Report
Percentage of oropharynx cancer patients who visited the emergency department during curative radiation treatment  Black Arrow Down  Yellow Arrow Level
Percentage of cervical cancer patients who visited the emergency department during curative radiation treatment  Black Arrow Down  Grey Arrow Null
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Among patients with oropharynx cancer who were undergoing a course of curative radiation therapy from 2012 to 2015, 29% visited the emergency department (ED). Twenty percent (20%) of patients with cervical cancer who were undergoing a course of curative radiation therapy from 2012 to 2015 visited the ED. This suggests that there may be room to improve the provision and coordination of supportive care for patients who are already visiting the hospital on a daily basis for treatment. The main reasons for ED visits among oropharynx cancer patients include neutropenia (an abnormally low count of white blood cells, which help fight infections), fever and infections (largely related to chemotherapy), as well as nausea, vomiting and dehydration. 

Side effects of radiation treatment

  • Oropharynx cancer develops in the posterior aspect of the mouth. The sub-sites of the oropharynx are the tonsillar complex, base of tongue, soft palate and pharyngeal walls1.
  • Cervical cancer is a malignant tumour that starts in the cells of the cervix2.
  • Side effects can occur with all cancer treatments, but not every patient experiences them. General side effects of radiation therapy can occur when radiation is given to any area of the body, but they depend on a number of factors, including the specific area or organs being treated, the size of the area being treated and the type of radiation therapy being administered.
  • A large proportion of studies related to the side effects of radiation therapy emphasize the late effects that manifest as a result of toxicities from radiotherapy3.
  • Common acute side effects include fatigue, skin reactions and changes in appetite.
  • One common side effect from radiation treatment for head and neck cancers (such as cancer of the oropharynx) is dysphagia (difficulty swallowing). Dysphagia has been acknowledged as a potentially dose-limiting toxicity of radiotherapy-based treatments for head and neck cancers, and it can have long-term effects3. Additionally, acute toxicities such as mucositis (inflammation of the mouth and throat) and edema (swelling) commonly disrupt normal swallowing during treatment, but they do improve substantially in the majority of patients in the months following radiotherapy4.
  • Common side effects of radiation therapy for cervical cancer include (but are not limited to) fatigue, nausea and vomiting, bowel problems, skin reactions, upset stomach, bladder problems and genital and reproductive organ changes5.
  • Radiation therapy has been identified as a highly effective method of treating oropharynx and cervical cancers, either as a single-modality treatment or combined with chemotherapy.
  • Patients receiving concurrent chemotherapy with radiation can often suffer from side effects such as neutropenia, fevers or infections, as well as nausea, dehydration and vomiting.
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What do the results show?

Twenty-nine percent (29%) of oropharynx cancer patients visited the ED during a course of radiation treatment (Figure 1).

  • From 2012 to 2015, almost 30% of oropharynx cancer patients visited the ED during a course of radiation therapy in Ontario (Figure 1).
  • There was some variation across the region. In the North West Regional Cancer Program, the ED is often used for planned hospital visits. This may contribute to elevated rates.
  • Reasons for these visits included neutropenia, fever and infections (which are largely related to chemotherapy), as well as nausea, vomiting and dehydration (data not shown). Due to some data limitations, however, the reasons for many of these visits are not available.
  • Provision of alternative strategies and clinics to deal with these patient issues outside of normal working hours would seem to be an appropriate goal.
  • Unplanned hospital visits also are reported on after cancer surgery and during a course of chemotherapy treatment .

Nineteen percent (19%) of cervical cancer patients visited the ED during a course of radiation treatment (Figure 2).

  • From 2012 to 2015, almost 20% of cervical patients visited the ED during a course of radiation therapy in Ontario (Figure 2).
  • There was some variation across the region, with Champlain reporting a slightly higher proportion of visits and admissions to the ED (28%) from April 2012 to March 2015.

Why is this important to patient care?

Appropriate management of treatment-related side effects can reduce the number of hospital visits and improve the quality of life for patients.

  • There is no standard for an acceptable rate of ED visits for patients receiving curative radiation treatment (with or without chemotherapy) for oropharynx or cervical cancer. Most cancer patients will experience some side effects from their treatment, but given that patients will vary in their side effects from their radiotherapy, individualized treatment plans should be developed. Appropriate resources should be available to these patients during treatment.
  • Effective management of these treatment-related side effects in care settings other than the ED would decrease hospital ED visits and likely improve the quality of life for patients.

Find out more

View Notes

  1. Skinner HD, Holsinger FC, Beadle BM. Oropharynx cancer. Curr Prob Cancer. 2012; 36(6):334–415.
  2. Cancer.ca [Internet]. Toronto: Canadian Cancer Society: c2016. Cervical cancer. Available from: http://www.cancer.ca/en/cancer-information/cancer-type/cervical/cervical-cancer/?region=on.
  3. Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008; 26:3582–9.
  4. Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MWS, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012; 118(3):5793–5799.
  5. Cancer.ca [Internet]. Toronto: Canadian Cancer Society; c2016. Side effects of radiation therapy for cervical cancer. Available from: http://www.cancer.ca/en/cancer-information/cancer-type/cervical/treatment/radiation-therapy/side-effects/?region=nu.