Abstract
PURPOSE: Most chemotherapy (CT) administration occurs in routine care settings, yet little is known about treatment-related toxicity outside of clinical trials. To examine trends in toxicity, modify practice, and establish benchmarks for severe toxicity in a community cancer center we created a prospective registry of all treatment-related hospitalizations at the North Shore Medical Center Cancer Center, a community-based cancer facility in Peabody, MA. METHODS: Eligible population consisted of all adult cancer patients admitted to the hospital within 30 days of their last CT administration. Each admission was reviewed by a panel of hospital staff to determine whether admission was treatment-related. Information on admission was collected using a standard form. RESULTS: Between October 2001 and December 2003, there were 365 hospitalizations among patients receiving CT, 117 (32%) of which were deemed treatment-related. The median age of the cohort with treatment-related toxicity was 67 years, and 41% were male. Most frequent diagnoses were non-Hodgkin's lymphoma (23%) and colorectal cancer (21%), with 49% of the patients receiving treatment with palliative intent. The most common reasons for admission were gastrointestinal toxicity or infection. The mean length of stay was 7.1 days. Seven patients (6%) died during hospitalization. When the registry was reviewed to identify areas where care may be improved, several admissions for decadron-related hyperglycemia in nondiabetic patients with myeloma were noted. This led to introduction of glucose monitoring guidelines with no subsequent admissions for this toxicity since then. CONCLUSIONS: About one third of hospital admissions in patients receiving CT are treatment-related and most occur in patients with advanced disease. Collection of data on toxicity in the routine care setting is feasible and may facilitate quality improvement.