The following article features coverage from the American Society of Hematology (ASH) 2018 meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

Approximately 25% of patients with breast cancer patients receiving highly emetogenicchemotherapy (HEC) visit the emergency room within 30 days of treatment, according to a study presented at the 2018 San Antonio Breast Cancer Symposium. Many of these visits were potentially avoidable.

Avoiding unnecessary inpatient and emergency room visits improves both patient care and reduces the cost of cancer treatment. According to the US Centers for Medicare and Medicaid Services (CMS), 20% of chemotherapy treatments cause adverse toxicities, including anemia, dehydration, diarrhea, fever, nausea, emesis, neutropenia, pain, pneumonia, or sepsis, that result in avoidable inpatient or emergency room visits. However, the rate of such events specifically in patients receiving HEC for breast cancer has been understudied until now.

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The study utilized a large electronic health record database to identify breast cancer patients who received highly emetogenic chemotherapy between 2012 and 2017; 2304 patients received anthracycline + cyclophosphamide (AC),  1721 received carboplatin, and 103 received cisplatin. 

Within 30-days of treatment 22% of patients receiving AC, 30% receiving carboplatin, and 23% receiving cisplatin had an inpatient or emergency room visit. Such visits were associated with 1 of the 10 CMS-defined toxicities for 73%, 72%, and 76% of patients receiving AC, carboplatin, and cisplatin, respectively. 

The most commonly reported adverse effects were pain (53%/49%/63%), anemia (51%/51%/38%), fever (48%/31%/38%), neutropenia (46%/27%/31%), and nausea/emesis (30%/40%/25%). “Toxicity prevention and symptom monitoring are crucial to reduce acute care needs,” wrote the study authors.

Reference

Ruddy KJ, Roeland EJ, LeBlanc TW, et al. Avoidable acute care use associated with nausea and emesis among patients receiving AC, carboplatin, or cisplatin for breast cancer. Poster presentation at: 2018 San Antonio Breast Cancer Symposium; December 4-8, 2018; San Antonio, TX. Abstract P4-16-05.