DISCUSSION

This study was undertaken to assess whether or not checking vital signs on the day of chemotherapy administration is associated with higher complication rates (eg, ED visits, hospitalizations). Our study findings indicate this was not the case. Rather, the opposite was found: Checking vital signs on the day of chemotherapy administration appears to be associated with higher rates of ED visits and hospitalizations. However, these findings do not indicate that checking vital signs leads to higher rates of complications; rather, patients who appeared ill presumably had their vital signs checked only because they appeared ill; these patients were subsequently referred to the ED or were hospitalized. Thus, the findings of this study suggest that not checking vital signs routinely prior to the administration of intravenous chemotherapy does not have adverse consequences.

The role of routinely checking vital signs is also being questioned in other areas of clinical medicine. Historically, checking vital signs was an essential, mandatory component of patient care. However, more recent studies — some of which include the routine monitoring of vital signs in hospitalized patients — have questioned the value of this practice and suggest that patients present with other symptoms or signs well before they manifest a concerning change in their vital signs.2,3 In hospital settings, the concern for compromising patient sleep, as well as escalating health care costs, has also led to the omission or curtailing of routine vital sign checks.4,5 Although the role of routinely checking vital signs continues to remain controversial, emerging trends show that this practice has been discontinued in some circumstances.10,11


Continue Reading

A critical distinction should be made between routinely checking vital signs and checking vital signs when patients appear ill or when patients are receiving antineoplastic agents that put them at risk for hypertension. Patients who fall within these latter 2 categories should continue to have vital signs checked. We acknowledge that patients with cancer who are ill or asymptomatic but who are receiving a medication such as bevacizumab should have at least a partial set of vital signs obtained.

Limitations

The retrospective nature of this study makes it impossible to determine why the checking of vital signs occurred or did not outside the routine practice of each specific institution. On day 1, or close to day 1, patients are likely to see their health care professional, who has performed an in-depth assessment of their status. Therefore, one might suggest that nurses can forgo checking vital signs if a physician had seen the patient at some very recent time point. Furthermore, patients with abnormal vital signs during their visit with their oncologist might have been deflected from receiving chemotherapy, resulting in a bias toward seeing normal vital signs on day 1 prior to administering chemotherapy. Of note, the foregoing is speculative, thus emphasizing the limitations of the design used in this study.

This study might have been underpowered with respect to determining whether early interventions, such as hospitalization, based on abnormal vital signs would have prevented more serious complications. We were unable to derive such information from a retrospective study.

In addition, the data from the current study are not derived from a randomized trial. As a result, comparative participant groups might be imbalanced with respect to institutional practices that could have influenced complication rates or patient predisposition for chemotherapy toxicity. If a prospective trial were to be performed, then the focus of that study should be on asymptomatic patients alone, with the exclusion of those receiving chemotherapy agents that might increase blood pressure. It would also be important to balance study arms based on the extent of prior cancer therapy and other factors that tend to lead to greater chemotherapy toxicity. One might argue that the great challenges of performing such a trial add to the importance of the data presented in this paper.

CONCLUSION

Our findings question whether the absence of evidence to support the checking of vital signs should lead to the conclusion that vital signs should be obtained. At the very least, these study results call for further evidence-based data to assess this routine, expense- generating clinical practice.

References

1. Neuss MN, Polovich M, McNiff K, et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013;9(2 suppl):5s-13s.

2. Storm-Versloot MN, Verweij L, Lucas C, et al. Clinical relevance of routinely measured vital signs in hospitalized patients: a systematic review. J Nurs Scholarsh. 2014;46(1):39-49.

3. Evans D, Hodgkinson B, Berry J. Vital signs in hospital patients: a systematic review. Int J Nurs Stud. 2001;38(6):643-650.

4. Fukayama H, Yagiela JA. Monitoring of vital signs during dental care. Int Dent J. 2006;56(2):102-108.

5. Leinonen T, Leino-Kilpi H. Research in peri-operative nursing care. J Clin Nurs. 1999;8(2):123-138.

6. Elshaug AG, McWilliams JM, Landon BE. The value of low-value lists. JAMA. 2013 Feb 27;309(8):775-6.

7. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074-2084.

8. Attal M, Harousseau JL, Stoppa AM, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N Engl J Med. 1996;335(2):91-97.

9. Child JA, Morgan GJ, Davies FE, et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003;348(19):1875-1883.

10. Pellicane AJ. Relationship between nighttime vital sign assessments and acute care transfers in the rehabilitation inpatient. Rehabil Nurs. 2014;39(6):305-310.

11. Bartick MC, Thai X, Schmidt T, et al. Decrease in as-needed sedative use by limiting nighttime sleep disruptions from hospital staff. J Hosp Med. 2010;5(3):E20-E24. 

Source: Cancer Control
Originally published