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Unplanned Hospital Visits during Chemotherapy

Key findings

Forty-five percent (45%) of breast cancer patients who receive adjuvant chemotherapy, 48% of colon cancer patients who receive adjuvant IV chemotherapy, 38% of patients who receive adjuvant oral-chemotherapy and 52% of lymphoma patients who receive chemotherapy visit the emergency department (ED) or are admitted to hospital at least once during the course of chemotherapy treatment. A high number of patients visit a second or third time. These results suggest that side effects do occur and resources are needed for patients to self-manage complications where appropriate, while also having a place where they can call or go when they require evaluation or management.

Measure:  Percentage of breast, colon and lymphoma cancer patients visiting the hospital at least once during a course of chemotherapy treatment

 

Desired Direction:

 

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As of this Report:

 

An image of an arrow pointing straight in a yellow box. This indicates that there has been no increase or decrease in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

What are chemotherapy, adjuvant chemotherapy and neutropenia?

  • Chemotherapy treatment is the use of drugs that slow or stop cancer cells from growing, multiplying or spreading to other parts of the body [1]. Chemotherapy is administered in the form of pills (oral), injection or intravenously (IV).
  • Chemotherapy is often given in cycles to allow the body to rest and recover.
  • Adjuvant chemotherapy means that chemotherapy treatment is given after the removal of tumours through cancer surgery. Adjuvant chemotherapy has been shown to increase the chance of killing any remaining non-visible cancer cells, prevent recurrence (return) of cancer, prolong life and improve the chance of curing a patient’s cancer.
  • In addition to destroying cancerous cells, chemotherapy drugs can suppress bone marrow function by killing white blood cells, which are essential for protection against illness and disease. As a result, patients receiving chemotherapy treatment may be more likely to develop infections.
  • A decrease in neutrophils, a type of white blood cell, is called neutropenia. If accompanied by a fever, it is called febrile neutropenia, and it can be a sign of an underlying infection.
  • In treating lymphoma, the most common combination of drugs used is a regimen called CHOP, which includes the drugs cyclophosphamide, doxorubicin, vincristine and prednisone(can be referred to as prednisolone). CHOP is often combined with targeted therapy, which focuses on a specific protein associated with the lymphoma, leading to the destruction of these cancer cells [2]. Often, the antibody rituximab (Rituxan®) is used in combination with chemotherapy drugs (where it is known as R-CHOP).

What is the New Drug Funding Program?

  • The New Drug Funding Program (NDFP) provides equal drug access for all Ontarians by paying for chemotherapy regimens that have been evaluated and approved for coverage by the Ministry of Health and Long-Term Care.
  • This section measures how many breast, colon and lymphoma cancer patients being treated with NDFP drugs, either after surgery or as a primary treatment, visited the ED 1 or more times for care and/or needed to be admitted to hospital over the total duration of their chemotherapy treatment.

What is an unplanned visit during chemotherapy?

  • An unplanned visit occurs when a patient has an ED visit or is admitted to the hospital during a course of chemotherapy treatment, presumably because of a side effect or adverse event.

I had a number of problems with chemo – lots of side effects – none of which anyone prepared me for or much assistance how to cope with them - I struggled through.

Joanne M., Patient/Family Advisor

Figure 1. Percentage of breast cancer, colon cancer (receiving IV and oral chemotherapy) and lymphoma patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

 

Report date: January 2018

Data source: OCR, NACRS, DAD, ODB, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. Colon cancer includes patients treated with IV and patients treated with oral-chemotherapy.
  2. If patients are admitted through ED on the same day or on the following day, it is counted as a single visit.

 

Figure 2. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by Local Health Integration Network (LHIN) of first chemotherapy facility

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. † Values have been suppressed due to small cell counts

 

Figure 3. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by year

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

 

Figure 4. Percentage of breast cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by Local Health Integration Network (LHIN) and year

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January, 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

 

Figure 5. Percentage of breast cancer, colon cancer (receiving IV chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by age

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January, 2018

Data source: OCR,NACRS, DAD, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. † Values have been suppressed due to small cell counts
  2. p-value 0.0017, =0.002, and .0002 for breast, colon (without including group of 18-29) and lymphoma cancer, respectively, by chi-square test.

 

Figure 6. Percentage of colon cancer patients (diagnosed from 2010 to 2015) receiving provincially funded oral chemotherapy who visited the hospital at least once during treatment, by age

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January, 2018

Data source: OCR,NACRS, DAD, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. p-value=0.4094 by chi-square test.

 

Figure 7. Percentage of breast cancer, colon cancer (receiving IV and oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital more than once during treatment

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January, 2018

Data source: OCR, NACRS, DAD, ODB, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

 

Figure 8. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital during treatment, by visit time (all visits)

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January, 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. Weekday business hours: 8 am to 5 pm (Monday-Friday);
  2. Weekday evening: 5 pm to 12 am (Monday-Thursday);
  3. Weekday overnight: 12 am to 8 am (Tuesday-Friday);
  4. Weekend: 5 pm Friday to 8 am Monday

 

Figure 9. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital during treatment, by visit type and time

More information regarding the methodology is available. This figure used multiple methodologies including Methodology 2.3.a, Methodology 2.3.b, Methodology 2.3.c and Methodology 2.3.d.

Report date: January, 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

For indirect hospital admission, visit time = indirect hospital admission time

  1. Weekday business hours: 8 am to 5 pm (Monday-Friday);
  2. Weekday evening: 5 pm to 12 am (Monday-Thursday);
  3. Weekday overnight: 12 am to 8 am (Tuesday-Friday);
  4. Weekend: 5 pm Friday to 8 am Monday


† Values have been suppressed due to small cell counts

 

Data Table 2. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by Local Health Integration Network (LHIN) of first chemotherapy facility

LHIN Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during adjuvant chemotherapy Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy Breast cancer lower confidence interval (%) Breast cancer upper confidenced interval(%) Percentage of colon cancer patients who had an ED visit or hospital admission during intravenous chemotherapy Number of colon cancer (stage 3) patients with ED visit or hospital admission during intravenous chemotherapy Number of colon cancer (stage 3) patients treated with intravenous adjuvant chemotherapy Colon-IV lower confidence interval (%) Colon-IV upper confidence interval (%) Percentage of colon cancer patients (age 65+) who had an ED visit or hospital admission during oral chemotherapy Number of colon cancer (age 65+, stage 3) patients with ED visit or hospital admission during oral chemotherapy Number of colon cancer (age 65+, stage 3) patients treated with oral chemotherapy Colon-oral lower confidence interval (%) Colon-oral upper confidence interval (%) Percentage of lymphoma cancer patients who had an ED visit or hospital admission during chemotherapy Number of lymphoma patients with ED visit or hospital admission during chemotherapy (R-CHOP) Number of lymphoma patients treated with R-CHOP treatment Lymphoma lower confidence interval (%) Lymphoma upper confidence inerval (%)
Ontario 47.3 7,636 16,138 46.5 48.1 50.4 1,127 2,238 48.3 52.5 40.1 36.6 43.6 60.7 2,369 3,902 59.2 62.3
Erie St. Clair 43.3 330 763 39.7 46.8 42.2 35 83 30.9 53.4 46.0 17 37 28.5 63.4 64.9 122 188 57.8 72.0
South West 53.5 648 1,212 50.6 56.3 54.0 94 174 46.3 61.7 34.2 28 82 23.3 45.0 63.5 209 329 58.2 68.9
Waterloo Wellington 44.1 340 771 40.5 47.7 47.3 53 112 37.6 57.0 46.3 25 54 32.1 60.5 62.4 121 194 55.3 69.5
Hmltn-Ngr-Hldmnd-Brnt 38.7 731 1,890 36.5 40.9 46.1 118 256 39.8 52.4 39.5 49 124 30.5 48.5 57.8 270 467 53.2 62.4
Central West 54.1 350 647 50.2 58.0 65.1 69 106 55.6 74.6 45.7 16 35 27.8 63.7 53.8 64 119 44.4 63.2
Mississauga Halton 42.8 565 1,321 40.1 45.5 51.0 77 151 42.7 59.3 20.4 10 49 8.1 32.7 56.9 149 262 50.7 63.1
Toronto Central 44.3 1,107 2,501 42.3 46.2 45.4 103 227 38.7 52.1 41.1 23 56 27.3 54.9 59.6 407 683 55.8 63.3
Central 40.6 688 1,696 38.2 42.9 38.0 98 258 31.9 44.1 38.4 28 73 26.5 50.2 54.7 187 342 49.3 60.1
Central East 52.4 835 1,595 49.9 54.8 49.4 118 239 42.8 55.9 38.6 34 88 27.9 49.4 57.6 193 335 52.2 63.1
South East 61.1 328 537 56.9 65.3 54.6 53 97 44.2 65.1 42.2 19 45 26.7 57.8 69.2 117 169 62.0 76.5
Champlain 46.1 773 1,676 43.7 48.5 52.4 130 248 46.0 58.8 40.5 30 74 28.7 52.4 62.1 283 456 57.5 66.6
North Simcoe Muskoka 52.4 284 542 48.1 56.7 51.0 51 100 40.7 61.3 42.4 14 33 24.1 60.8 67.0 79 118 58.0 75.9
North East 66.7 471 706 63.2 70.3 67.2 90 134 58.8 75.5 55.6 20 36 37.9 73.2 69.9 114 163 62.6 77.3
North West 66.2 186 281 60.5 71.9 71.7 38 53 58.6 84.8 80.0 34.9 100.0 70.1 54 77 59.3 81.0

Report date: January 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. † Values have been suppressed due to small cell counts

 

Data Table 3. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by year

Cancer type Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy in 2010 Number of cancer patients with ED visit or hospital admission during chemotherapy in 2010 Number of cancer patients treated with adjuvant chemotherapy in 2010 Lower confidence interval (%) in 2010 Upper confidence interval (%) in 2010 Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy in 2011 Number of cancer patients with ED visit or hospital admission during chemotherapy in 2011 Number of cancer patients treated with adjuvant chemotherapy in 2011 Lower confidence interval (%) in 2011 Upper confidence interval (%) in 2011 Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy in 2012 Number of cancer patients with ED visit or hospital admission during chemotherapy in 2012 Number of cancer patients treated with adjuvant chemotherapy in 2012 Lower confidence inteval (%) in 2012 Upper confidence interval (%) in 2012 Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy in 2013 Number of cancer patients with ED visit or hospital admission during chemotherapy in 2013 Number of cancer patients treated with adjuvant chemotherapy in 2013 Lower confidence interval (%) in 2013 Upper confidence interval (%) in 2013 Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy in 2014 Number of cancer patients with ED visit or hospital admission during chemotherapy in 2014 Number of cancer patients treated with adjuvant chemotherapy in 2014 Lower confidence interval (%) in 2014 Upper confidence interval (%) in 2014 Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy in 2015 Number of cancer patients with ED visit or hospital admission during chemotherapy in 2015 Number of cancer patients treated with adjuvant chemotherapy in 2015 Lower confidence interval (%) in 2015 Upper confidence interval (%) in 2015 Percentage of cancer patients who had an ED visit or hospital admission during chemotherapy from 2010 to 2015 Number of cancer patients with ED visit or hospital admission during chemotherapy from 2010 to 2015 Number of cancer patients treated with adjuvant chemotherapy from 2010 to 2015 Lower confidence interval (%) from 2010 to 2015 Upper confidence interval (%) from 2010 to 2015
Breast 47.3 1,245 2,633 45.4 49.2 48.6 1,225 2,521 46.6 50.6 48.9 1,235 2,528 46.9 50.8 48.3 1,267 2,621 46.4 50.3 47.3 1,349 2,853 45.4 49.1 44.1 1,315 2,982 42.3 45.9 47.3 7,636 16,138 46.5 48.1
Colon-IV 46.7 177 379 41.6 51.9 48.7 173 355 43.4 54.1 50.4 187 371 45.2 55.6 48.4 185 382 43.3 53.6 53.9 199 369 48.7 59.2 53.9 206 382 48.8 59.1 50.4 1,127 2,238 48.3 52.5
Colon-oral 35.5 44 124 26.7 44.3 40.8 51 125 31.8 49.8 42.3 55 130 33.4 51.2 36.1 53 147 28.0 44.2 42.9 54 126 33.8 51.9 43.2 60 139 34.6 51.8 40.1 317 791 36.6 43.6
Lymphoma 58.6 327 558 54.4 62.8 63.4 404 637 59.6 67.2 60.4 390 646 56.5 64.2 63.6 421 662 59.9 67.3 59.3 401 676 55.5 63.1 58.9 426 723 55.3 62.6 60.7 2,369 3,902 59.2 62.3

Report date: January 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

 

Data Table 4. Percentage of breast cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by Local Health Integration Network (LHIN) and year

LHIN Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy in 2010 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy in 2010 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy in 2010 Lower confidence interval (%) in 2010 Upper confidence interval (%) in 2010 Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy in 2011 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy in 2011 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy in 2011 Lower confidence interval (%) in 2011 Upper confidence interval (%) in 2011 Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy in 2012 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy in 2012 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy in 2012 Lower confidence interval (%) in 2012 Upper confidence interval (%) in 2012 Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy in 2013 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy in 2013 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy in 2013 Lower confidence interval (%) in 2013 Upper confidence interval (%) in 2013 Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy in 2014 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy in 2014 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy in 2014 Lower confidence interval (%) in 2014 Upper confidence interval (%) in 2014 Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy in 2015 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy in 2015 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy in 2015 Lower confidence interval (%) in 2015 Upper confidence interval (%) in 2015 Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy from 2010 to 2015 Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy from 2010 to 2015 Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy from 2010 to 2015 Lower confidence interval (%) from 2010 to 2015 Upper confidence interval (%) from 2010 to 2015
Ontario 47.3 1,245 2,633 45.4 49.2 48.6 1,225 2,521 46.6 50.6 48.9 1,235 2,528 46.9 50.8 48.3 1,267 2,621 46.4 50.3 47.3 1,349 2,853 45.4 49.1 44.1 1,315 2,982 42.3 45.9 47.3 7,636 16,138 46.5 48.1
Erie St. Clair 46.3 44 95 35.8 56.9 32.3 31 96 22.4 42.2 41.2 56 136 32.5 49.8 43.8 64 146 35.4 52.2 51.6 64 124 42.4 60.8 42.8 71 166 34.9 50.6 43.3 330 763 39.7 46.8
South West 52.4 99 189 45.0 59.8 51.6 100 194 44.3 58.8 63.8 132 207 57.0 70.6 53.0 96 181 45.5 60.6 52.2 105 201 45.1 59.4 48.3 116 240 41.8 54.9 53.5 648 1,212 50.6 56.3
Waterloo Wellington 47.0 63 134 38.2 55.8 36.4 47 129 27.7 45.1 43.3 45 104 33.3 53.3 43.0 61 142 34.5 51.5 43.6 54 124 34.4 52.7 50.7 70 138 42.0 59.4 44.1 340 771 40.5 47.7
Hmltn-Ngr-Hldmnd-Brnt 37.9 121 319 32.5 43.4 42.1 114 271 36.0 48.1 40.2 113 281 34.3 46.1 45.0 134 298 39.2 50.8 35.5 125 352 30.4 40.7 33.6 124 369 28.7 38.6 38.7 731 1,890 36.5 40.9
Central West 46.7 57 122 37.5 56.0 57.7 60 104 47.7 67.7 50.6 44 87 39.5 61.7 52.2 59 113 42.6 61.9 59.1 68 115 49.7 68.6 58.5 62 106 48.6 68.3 54.1 350 647 50.2 58.0
Mississauga Halton 41.2 98 238 34.7 47.6 42.7 91 213 35.8 49.6 44.9 96 214 38.0 51.8 45.3 96 212 38.4 52.2 39.9 95 238 33.5 46.4 43.2 89 206 36.2 50.2 42.8 565 1,321 40.1 45.5
Toronto Central 45.3 192 424 40.4 50.1 46.2 201 435 41.4 51.0 43.9 175 399 38.9 48.9 43.9 165 376 38.7 49.0 42.5 179 421 37.7 47.4 43.7 195 446 39.0 48.4 44.3 1,107 2,501 42.3 46.2
Central 41.3 123 298 35.5 47.0 43.0 111 258 36.8 49.3 44.4 112 252 38.1 50.8 40.5 120 296 34.8 46.3 37.7 116 308 32.1 43.2 37.3 106 284 31.5 43.1 40.6 688 1,696 38.2 42.9
Central East 58.3 147 252 52.1 64.6 60.4 139 230 53.9 67.0 51.4 130 253 45.0 57.7 49.8 126 253 43.4 56.2 52.0 153 294 46.2 57.9 44.7 140 313 39.1 50.4 52.4 835 1,595 49.9 54.8
South East 61.6 45 73 49.8 73.5 65.5 55 84 54.7 76.2 59.3 54 91 48.7 70.0 60.4 55 91 49.8 71.0 65.9 54 82 55.0 76.7 56.0 65 116 46.6 65.5 61.1 328 537 56.9 65.3
Champlain 47.1 120 255 40.7 53.4 46.8 118 252 40.5 53.2 48.0 120 250 41.6 54.4 51.2 128 250 44.8 57.6 48.4 154 318 42.8 54.1 37.9 133 351 32.7 43.1 46.1 773 1,676 43.7 48.5
North Simcoe Muskoka 53.2 42 79 41.5 64.8 45.9 39 85 34.7 57.1 52.8 48 91 41.9 63.6 50.0 47 94 39.4 60.6 63.2 60 95 52.9 73.4 49.0 48 98 38.6 59.4 52.4 284 542 48.1 56.7
North East 61.0 64 105 51.1 70.8 73.6 89 121 65.3 81.8 70.5 86 122 62.0 79.0 66.9 83 124 58.3 75.6 64.5 80 124 55.7 73.3 62.7 69 110 53.2 72.2 66.7 471 706 63.2 70.3
North West 60.0 30 50 45.4 74.6 61.2 30 49 46.6 75.9 58.5 24 41 42.2 74.8 73.3 33 45 59.3 87.4 73.7 42 57 61.4 86.0 69.2 27 39 53.5 85.0 66.2 186 281 60.5 71.9

Report date: January, 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

 

Data Table 5. Percentage of breast cancer, colon cancer (receiving IV chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by age

Age group Percentage of breast cancer patients who had an ED visit or hospital admission during chemotherapy Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy Number of breast cancer (stage 1 to 3) patients treated with adjuvant chemotherapy Breast cancer lower confidence interval (%) Breast cancer upper confidence interval (%) Percentage of colon cancer patients who had an ED visit or hospital admission during intravenous chemotherapy Number of colon cancer (stage 3) patients with ED visit or hospital admission during chemotherapy Number of colon cancer (stage 3) patients treated with intravenous adjuvant chemotherapy Colon-IV lower confidence interval (%) Colon-IV upper confidence interval (%) Percentage of lymphoma cancer patients who had an ED visit or hospital admission during chemotherapy Number of lymphoma patients with ED visit or hospital admission during chemotherapy (R-CHOP) Number of lymphoma patients treated with R-CHOP treatment Lymphoma lower confidence inteval (%) Lymphoma upper confidence interval (%)
18 to 29 59.2 77 130 50.4 68.1 30.8 1.8 59.7 61.2 93 152 53.1 69.3
30 to 49 48.0 2,450 5,107 46.6 49.4 47.8 149 312 42.1 53.5 54.7 291 532 50.4 59.0
50 to 64 46.0 3,466 7,538 44.9 47.1 47.9 493 1,029 44.8 51.0 57.7 696 1,206 54.9 60.5
65 to 79 49.0 1,579 3,225 47.2 50.7 53.7 459 855 50.3 57.1 63.6 946 1,487 61.1 66.1
80+ 46.4 64 138 37.7 55.1 75.9 22 29 58.6 93.2 65.3 343 525 61.2 69.5

Report date: January, 2018

Data source: OCR,NACRS, DAD, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. † Values have been suppressed due to small cell counts
  2. p-value 0.0017, =0.002, and .0002 for breast, colon (without including group of 18-29) and lymphoma cancer, respectively, by chi-square test.

 

Data Table 6. Percentage of colon cancer patients (diagnosed from 2010 to 2015) receiving provincially funded oral chemotherapy who visited the hospital at least once during treatment, by age

Age group Percentage of colon cancer patients (age 65+) who had an ED visit or hospital admission during oral chemotherapy Number of colon cancer (age 65+, stage 3) patients with ED visit or hospital admission Number of colon cancer (age 65+, stage 3) patients treated with oral chemotherapy (capecitabine/Xeloda®) Lower confidence intervals (%) Upper confidence intervals (%)
65 to 70 37.0 44 119 27.9 46.1
71 to 80 39.2 182 464 34.7 43.8
80+ 43.8 91 208 36.8 50.7

Report date: January, 2018

Data source: OCR,NACRS, DAD, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. p-value=0.4094 by chi-square test.

 

Data Table 7. Percentage of breast cancer, colon cancer (receiving IV and oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital more than once during treatment

ED revisit/readmission sequence Percentage of breast cancer patients who had an ED revisit or hospital readmission during chemotherapy Number of breast cancer (stage 1 to 3) patients with ED revisit or hospital readmission during chemotherapy Number of breast cancer (stage 1 to 3) patients with ED visit or hospital admission during chemotherapy Breast cancer lower confidence interval (%) Breast cancer upper confidence interval (%) Percentage of colon cancer patients who had an ED revisit or hospital readmission during intravenous chemotherapy Number of colon cancer (stage 3) patients with ED revisit or hospital readmission during intravenous chemotherapy Number of colon cancer (stage 3) patients with ED visit or hospital admission during intravenous chemotherapy Colon-IV lower confidence interval (%) Colon-IV upper confidence interval (%) Percentage of colon cancer patients (age 65+) who had an ED revisit or hospital readmission during oral chemotherapy Number of colon cancer (age 65+, stage 3) patients with ED revisit or hospital readmission during oral chemotherapy Number of colon cancer (age 65+, Stage 3) patients with ED visit or hospital admission during oral chemotherapy Colon-oral lower confidence interval (%) Colon-oral upper confidence interval (%) Percentage of lymphoma cancer patients who had an ED revisit or hospital readmission during chemotherapy Number of lymphoma patients with ED revisit or hospital readmission during chemotherapy (R-CHOP) Number of lymphoma patients with ED visit or hospital admission during chemotherapy (R-CHOP) Lymphoma lower confidence interval (%) Lymphoma upper confidence interval (%)
2nd 47.2 3,602 7,636 46.1 48.3 47.9 540 1,127 45.0 50.9 40.1 127 317 34.5 45.6 59.3 1,405 2,369 57.3 61.3
3rd 23.3 1,775 7,636 22.3 24.2 24.6 277 1,127 22.0 27.1 17.4 55 317 13.0 21.7 36.3 859 2,369 34.3 38.2
4th 11.9 911 7,636 11.2 12.7 12.6 142 1,127 10.6 14.6 9.2 29 317 5.8 12.5 22.1 524 2,369 20.4 23.8
5th or more 6.2 475 7,636 5.7 6.8 7.4 83 1,127 5.8 8.9 2.2 7 317 0.4 4.0 12.9 305 2,369 11.5 14.2

Report date: January, 2018

Data source: OCR, NACRS, DAD, ODB, eClaims, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

 

Data Table 8. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital during treatment, by visit time (all visits)

Cancer Type Percentage of ED visits and hospital admissions during weekday business hours Number of ED visits and hospital admissions during weekday business hours Number of all ED visits and hospital admissions Weekday business hours lower confidence interval (%) Weekday business hours upper confidence interval (%) Percentage of ED visits and hospital admissions during weekday evening hours Number of ED visits and hospital admissions during weekday evening hours Number of all ED visits and hospital admissions Weekday evening hours lower confidence interval (%) Weekday evening hours upper confidence interval (%) Percentage of ED visits and hospital admissions during weekday overnight hours Number of ED visits and hospital admissions during weekday overnight hours Number of all ED visits and hospital admissions Weekday overnight hours lower confidence interval (%) Weekday overnight hours upper confidence interval (%) Percentage of ED visits and hospital admissions during weekend hours Number of ED visits and hospital admissions during weekend hours Number of all ED visits and hospital admissions Weekend hours lower confidence interval (%) Weekend hours upper confidence interval (%)
Breast 34.6 5,307 15,327 33.9 35.4 19.8 3,032 15,327 19.2 20.4 9.0 1,381 15,327 8.6 9.5 36.6 5,607 15,327 35.8 37.4
Colon-IV 39.4 948 2,408 37.4 41.3 18.2 438 2,408 16.6 19.8 7.9 191 2,408 6.8 9.0 34.5 831 2,408 32.6 36.4
Colon-oral (age 65+) 38.6 207 536 34.4 42.8 19.8 106 536 16.3 23.2 8.4 45 536 6.0 10.8 33.2 178 536 29.1 37.3
Lymphoma 38.0 2,279 5,995 36.8 39.3 20.9 1,251 5,995 19.8 21.9 9.6 576 5,995 8.9 10.4 31.5 1,889 5,995 30.3 32.7

Report date: January, 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. Weekday business hours: 8 am to 5 pm (Monday-Friday);
  2. Weekday evening: 5 pm to 12 am (Monday-Thursday);
  3. Weekday overnight: 12 am to 8 am (Tuesday-Friday);
  4. Weekend: 5 pm Friday to 8 am Monday

 

Data Table 9. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital during treatment, by visit type and time

Visit Percentage of all ED only visits by breast cancer (stage 1 to 3) patients during chemotherapy Number of all ED only visits by breast cancer (stage 1 to 3) patients during chemotherapy Number of all visits by breast cancer (stage 1 to 3) patients ED only visits by breast cancer patients lower confidence interval (%) ED only visits by breast cancer patients upper confidence interval (%) Percentage of all indIrect hospital admission visits by breast cancer (stage 1 to 3) patients during chemotherapy Number of all indIrect hospital admission visits by breast cancer (stage 1 to 3) patients during chemotherapy Number of all visits by breast cancer (stage 1 to 3) patients Indirect hospital admission visits by breast cancer patients lower confidence interval (%) Indirect hospital admission visits by breast cancer patients upper confidence interval (%) Percentage of all direct hospital admission visits by breast cancer (stage 1 to 3) patients during chemotherapy Number of all dIrect hospital admission visits by breast cancer (stage 1 to 3) patients during chemotherapy Number of all visits by breast cancer (stage 1 to 3) patients Direct hospital admission visits by breast cancer patients lower confidence interval (%) Direct hospital admission visits by breast cancer patients upper confidence interval (%) Percentage of all ED only visits by colon cancer (stage 3) patients during intravenous chemotherapy Number of all ED only visits by colon cancer (stage 3) patients during intravenous chemotherapy Number of all visits by colon-IV cancer (stage 3) patients ED only visits by colon-IV cancer patients lower confidence interval (%) ED only visits by colon-IV cancer patients upper confidence interval (%) Percentage of all indirect hospital admission visits by colon cancer (stage 3) patients during intravenous chemotherapy Number of all indirect hospital admission visits by colon cancer (stage 3) patients during intravenous chemotherapy Number of all visits by colon-IV cancer (stage 3) patients Indirect hospital admission visits by colon-IV cancer patients lower confidence interval (%) Indirect hospital admission visits by colon-IV cancer patients upper confidence interval (%) Percentage of all direct hospital admission visits by colon cancer (stage 3) patients during intravenous chemotherapy Number of all direct hospital admission visits by colon cancer (stage 3) patients during intravenous chemotherapy Number of all visits by colon cancer-IV (stage 3) patients Direct hospital admission visits by colon-IV cancer patients lower confidence interval (%) Direct hospital admission visits by colon-IV cancer patients upper confidence interval (%) Percentage of all ED only visits by colon cancer (age 65+, stage 3) patients during oral chemotherapy Number of all ED only visits by colon cancer (age 65+, stage 3) patients during oral chemotherapy Number of all visits by colon-oral cancer (age 65+, stage 3) patients ED only visits by colon-oral cancer patients lower confidence interval (%) ED only visits by colon-oral cancer patients upper confidence interval (%) Percentage of all indirect hospital admission visits by colon cancer (age 65+, stage 3) patients during oral chemotherapy Number of all indirect hospital admission visits by colon cancer (age 65+, stage 3) patients during oral chemotherapy Number of all visits by colon-oral cancer (age 65+, stage 3) patients Indirect hospital admission visits by colon-oral cancer patients lower confidence interval (%) Indirect hospital admission visits by colon-oral upper confidence interval (%) Percentage of all direct hospital admission visits by colon cancer (age 65+, stage 3) patients during oral chemotherapy Number of all direct hospital admission visits by colon cancer (age 65+, stage 3) patients during oral chemotherapy Number of all visits by colon-oral cancer (age 65+, stage 3) patients Direct hospital admission visits by colon-oral cancer patients lower confidence interval (%) Direct hospital admission visits by colon-oral cancer patients upper confidence interval (%) Percentage of all ED only visits by lymphoma cancer patients during chemotherapy Number of all ED only visits by lymphoma cancer patients during chemotherapy Number of all visits by lymphoma cancer patients ED only visits by lymphoma cancer patients lower confidence interval (%) ED only visits by lymphoma cancer patients upper confidence interval (%) Percentage of all indirect hospital admission visits by lymphoma cancer patients during chemotherapy Number of all indirect hospital admission visits by lymphoma cancer patients during chemotherapy Number of all visits by lymphoma cancer patients Indirect hospital admission visits by lymphoma cancer lower confidence interval (%) Indirect admission hospital visits by lymphoma cancer patients upper confidence interval (%) Percentage of of all direct hospital admission visits by lymphoma cancer patients during chemotherapy Number of all direct hospital admission visits by lymphoma cancer patients during chemotherapy Number of all visits by lymphoma cancer patients Direct hospital admission visits by lymphoma cancer patients lower confidence interval (%) Direct hospital admission visits by lympoma cancer patients upper confidence interval (%)
Weekday business hours 82.4 4,372 5,307 81.4 83.4 10.6 562 5,307 9.8 11.4 7.0 373 5,307 6.3 7.7 82.9 786 948 80.5 85.4 9.9 94 948 8.0 11.9 7.2 68 948 5.5 8.9 71.0 147 207 64.6 77.4 18.8 39 207 13.3 24.4 10.1 21 207 5.8 14.5 52.3 1,192 2,279 50.2 54.4 18.0 411 2,279 16.4 19.6 29.7 676 2,279 27.8 31.6
Weekday evening 72.3 2,192 3,032 70.7 73.9 24.1 730 3,032 22.5 25.6 3.6 110 3,032 3.0 4.3 73.1 320 438 68.8 77.3 21.5 94 438 17.5 25.4 5.5 24 438 3.2 7.7 58.5 62 106 48.6 68.3 29.3 31 106 20.1 38.4 12.3 13 106 5.6 19.0 42.0 525 1,251 39.2 44.7 35.0 438 1,251 32.3 37.7 23.0 288 1,251 20.7 25.4
Weekday overnight 46.6 644 1,381 44.0 49.3 42.2 583 1,381 39.6 44.9 11.2 154 1,381 9.5 12.9 49.7 95 191 42.4 57.1 30.4 58 191 23.6 37.2 19.9 38 191 14.0 25.8 37.8 17 45 22.5 53.1 48.9 22 45 33.2 64.6 13.3 6 45 2.3 24.4 35.9 207 576 31.9 39.9 60.4 348 576 56.3 64.5 3.7 21 576 2.0 5.3
Weekend 79.2 4,441 5,607 78.1 80.3 19.4 1,086 5,607 18.3 20.4 1.4 80 5,607 1.1 1.8 78.3 651 831 75.5 81.2 20.3 169 831 17.5 23.1 1.3 11 831 0.5 2.2 62.4 55.0 69.8 35.4 28.1 42.7 2.3 0.0 4.7 51.5 973 1,889 49.2 53.8 37.7 713 1,889 35.5 40.0 10.8 203 1,889 9.3 12.2

Report date: January, 2018

Data source: OCR, NACRS, DAD, eClaims, ODB, ALR and CSI

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

For indirect hospital admission, visit time = indirect hospital admission time

  1. Weekday business hours: 8 am to 5 pm (Monday-Friday);
  2. Weekday evening: 5 pm to 12 am (Monday-Thursday);
  3. Weekday overnight: 12 am to 8 am (Tuesday-Friday);
  4. Weekend: 5 pm Friday to 8 am Monday


† Values have been suppressed due to small cell counts

 

Figure 1. Percentage of breast cancer, colon cancer (receiving IV and oral chemotherapy) and lymphoma patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment

The figure is a flow chart with 11 labeled boxes linked by lines. Here the flow chart is described as lists in which the connections are listed beneath each box label. Each box label includes the relevant number and percentage of cancer patients.

Cancer patients receiving chemotherapy:

  • Breast: N = 16138
  • Colon-IV: N = 2238
  • Colon-Oral: N = 791
  • Lymphoma: N= 3902
    1. Connects to No ED/admission visit:
      • Breast: N = 8502 (53%)
      • Colon-IV: N = 1111 (50%)
      • Colon-Oral: N = 474 (60%)
      • Lymphoma: N = 1533 (39%)
        • Connects to Visited ED:
          • Breast: N = 7316 (45%)
          • Colon-IV: N = 1074 (48%)
          • Colon-Oral: N = 300 (38%)
          • Lymphoma: N = 2010 (52%)
            1. Connects No admission:
              • Breast: N = 5764 (79%)
              • Colon-IV: N = 865 (81%)
              • Colon-Oral: N = 203 (68%)
              • Lymphoma: N = 1167 (58%)
            2. Connects to Admitted:
              • Breast: N = 1552 (21%)
              • Colon-IV: N = 209 (19%)
              • Colon-Oral: N = 97 (32%)
              • Lymphoma: N = 843 (42%)
        • Connects to Direct admission to hospital:
          • Breast: N = 320 (2%)
          • Colon-IV: N = 53 (2%)
          • Colon-Oral: N = 17 (2%)
          • Lymphoma: N = 359 (9%)

Under 2 and 3 (that is, patients who visited ED or were directly admitted to hospital):

  1. Connects to No ED Revisit/Re-admission:
    • Breast: N = 4034 (53%)
    • Colon-IV: N = 587 (52%)
    • Colon-Oral: N = 190 (60%)
    • Lymphoma: N = 964 (41%)
  2. Connects to Revisited ED:
    • Breast: N = 3421 (45%)
    • Colon-IV: N = 501 (44%)
    • Colon-Oral: N = 114 (36%)
    • Lymphoma: N = 1122 (47%)
      1. Connects No admission:
        • Breast: N = 2701 (79%)
        • Colon-IV: N = 394 (79%)
        • Colon-Oral: N = 77 (68%)
        • Lymphoma: N = 676 (60%)
      2. Connects to Admitted:
        • Breast: N = 720 (21%)
        • Colon-IV: N = 107 (21%)
        • Colon-Oral: N = 37 (32%)
        • Lymphoma: N = 446 (40%)
  3. Connects to Direct admission to hospital:
    • Breast: N = 181 (2%)
    • Colon-IV: N = 39 (4%)
    • Colon-Oral: N = 13 (4%)
    • Lymphoma: N = 283 (12%)

Data Table 2. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by Local Health Integration Network (LHIN) of first chemotherapy facility Data Table 3. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by year Data Table 4. Percentage of breast cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by Local Health Integration Network (LHIN) and year Data Table 5. Percentage of breast cancer, colon cancer (receiving IV chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital at least once during treatment, by age Data Table 6. Percentage of colon cancer patients (diagnosed from 2010 to 2015) receiving provincially funded oral chemotherapy who visited the hospital at least once during treatment, by age Data Table 7. Percentage of breast cancer, colon cancer (receiving IV and oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital more than once during treatment Data Table 8. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital during treatment, by visit time (all visits) Data Table 9. Percentage of breast cancer, colon cancer (receiving IV or oral chemotherapy) and lymphoma cancer patients (diagnosed from 2010 to 2015) receiving provincially funded drugs who visited the hospital during treatment, by visit type and time

What do the results show?

ED visits and hospital admissions are common (Figures 1 to 4).

  • Forty-five percent (45%) of breast cancer patients who receive adjuvant chemotherapy, 48% of colon cancer patients who receive adjuvant IV chemotherapy (colon-IV), 38% of colon cancer patients who receive adjuvant oral chemotherapy (colon-oral) and 52% of lymphoma patients visited the ED at least once during chemotherapy treatment.
  • Of the patients who visited the ED at least once, 21% of breast cancer patients, 19% of colon-IV cancer patients, 32% of colon-oral cancer patients and 42% of lymphoma patients were admitted to hospital (Figure 1).
  • In addition to the patients who visited the ED, 2% of breast cancer patients, 2% of colon-IV cancer patients, 2% of colon-oral cancer patients and 9% of lymphoma patients were admitted directly to hospital.
  • There is some regional variation in patients who visited the hospital during treatment, ranging from 39% to 67% for breast cancer patients, 38% to 72% for colon-IV cancer patients, 20% to 80% for colon-oral cancer patients and 54% to 70% for lymphoma patients.
  • Time trend data indicate that unplanned hospital visits for colon and lymphoma cancer patients remained relative stable from 2010 to 2015 (Figures 3 and 4).
  • There has been a decrease in the number of unplanned hospital visits for breast cancer patients (from 47% in 2014 to 44% in 2015). This could be a result of the approval by the Ontario Drug Benefit of a new intervention (growth factor support using filgrastim, which is sold under the brand names of Grastofil® and Neupogen®) to decrease risk of febrile neutropenia, a known chemotherapy complication. It also could be a result of work done within the regions to expand access to knowledgeable oncology providers 24 hours a day, 7 days a week.
  • Unplanned hospital visits are also reported after cancer surgery.

Almost half of patients with breast or colon-IV cancer visited the ED a second time during a course of treatment. Percentages were even higher for lymphoma patients (Figures 5, 6 and 7).

  • About 47% of breast and 48% colon-IV cancer patients who visited the ED returned for a second ED visit, and approximately 23% of breast and 24% of colon-IV returned for a third visit. Forty percent (40%) of colon-oral cancer patients and 59% of lymphoma patients returned a second time, and 17% and 36%, respectively, returned a third time.
  • For breast and colon-IV cancer patients, 6% and 7%, respectively, returned to the hospital 5 or more times (compared to 2% of colon-oral patients and 13% of lymphoma patients).
  • Age and rate of hospital visits are positively associated among colon-IV and lymphoma cancer patients. Lymphoma patients and colon cancer patients who received IV chemotherapy had the highest unplanned hospital visits for patients age 65 and older.
  • Colon cancer patients age 80 and over who received oral chemotherapy had the highest rates (44%) of unplanned hospital visits during chemotherapy compared to other age groups (Figure 6).
  • This relationship does not hold true for breast cancer patients. Hospital visits differed by age and type of cancer. Breast cancer patients age 18 to 29 had the highest rates (59%) of visiting the hospital, compared to breast cancer patients age 80 and over (46%).
  • These differences in age could be related to younger breast cancer patients being treated with more aggressive regimens of chemotherapy drugs than lymphoma and colon cancer patients, who all would receive the same regimens.

Many hospital visits are happening during the day, with hospital admissions varying by type of cancer and time of day (Figures 8 and 9).

  • Approximately one-third of hospital visits took place during weekday business hours. About 37% of breast cancer, 35% of colon-IV cancer, 33% of colon-oral cancer and 31% of lymphoma patients had visits on the weekend.
  • The weekday overnight time period had the lowest rate of hospital visits for breast cancer, colon-IV cancer, colon-oral cancer and lymphoma patients. However, patients who visited a hospital at this time also had the highest risk of hospital admission.
  • Of the 4 patient groups, lymphoma patients had the highest rate of admission to hospital for any time of day, regardless of the day of the week.
  • The differences seen among the types of cancer and the time of visit may reflect that some patients experience more serious symptoms.
  • This analysis helps identify which visits may be preventable with better symptom management supports in the cancer system.

Why is this important to Ontarians?

Managing treatment-related side effects

  • While chemotherapy for breast cancer, colon cancer and lymphoma patients has helped improve outcomes, the potential for drug-related side effects must be taken into account when balancing improvement in survival with aggressiveness of treatment.
  • There is no standard for an acceptable rate of chemotherapy side effects.
  • These drug-related side effects are potentially predictable, and they should be taken into account when setting individual treatment plans and planning appropriate system resources to care for these patients.
  • By measuring the frequency of hospital visits resulting from the effects of chemotherapy treatment, Cancer Care Ontario aims to improve patient management and care by ensuring patients know who to call when they experience side effects and by eliminating unnecessary visits to the ED.
  • In the 2014 Ambulatory Oncology Patient Satisfaction Survey (AOPSS), 83% of breast and colorectal cancer patients and 82% of lymphoma patients responded that someone had either “yes, completely” or “yes, somewhat” told them how to manage any side effects of chemotherapy (data not shown).
  • These findings suggest that the problem is not whether information is being provided, but how and what information is being provided and how it is being used by patients. The hospital may be the appropriate place to evaluate and help certain patients, but there also may be other acceptable options.
  • Provision of alternative strategies and clinics to deal with these patient issues outside of normal working hours would seem to be an appropriate goal.

Neutropenia, fever and infection may be preventable

  • Growth factor support has been shown to decrease the rates of neutropenia after intravenous chemotherapy [3].
  • Using growth factors preventively after some adjuvant, neoadjuvant or curative chemotherapy regimens may help reduce the rates of neutropenia and its complications.

Appropriateness of using the emergency department and hospital care

  • Medical oncologists instruct patients to go to the ED if they experience serious side effects (such as fever) outside of normal clinic hours. Fever after chemotherapy needs to be evaluated quickly, and no other appropriate healthcare settings exist to receive patients when clinics are closed.
  • From the point of view of cancer patients, EDs may not be the most appropriate care setting for support, treatment or management of all side effects. Other models of care could be considered, such as management of low-risk patients by urgent care centres and 24/7 access to knowledgeable oncology providers by phone.

Find out more

For more information on the Systemic Treatment Program, please visit Cancer Care Ontario’s website.

Notes

  1. Zanke B, Evans WK. Systemic therapy: building on a strong base. In: Sullivan T, Evans W, Angus H, Hudson A, editors. Strengthening the quality of cancer services in Ontario. Ottawa: CHA Press; 2003.
  2. Immunotherapy for non-Hodgkin Lymphoma [Internet]. American Cancer Society; 2015 [updated 2017 Nov 16; cited 2016 Feb 29]. Available from here.
  3. Wingard JR, Elmongy M. Strategies for minimizing complications of neutropenia: prophylactic myeloid growth factors or antibiotics. Oncol Hematol. 2009;72:144–154.