Unplanned presentations of cancer outpatients: a retrospective cohort study

• Published in: Supportive care in cancer 2013-02, Vol.21 (2), p.397-404
• Main Authors: Aprile, G., Pisa, F. E., Follador, A., Foltran, L., De Pauli, F., Mazzer, M., Lutrino, S., Sacco, C. S., Mansutti, M., Fasola, G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Antineoplastic Agents - adverse effects; Cancer; Cancer Care Facilities - utilization; Chemotherapy; Female; Health services utilization; Hospitalization - statistics & numerical data; Humans; Italy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - classification; Neoplasms - complications; Neoplasms - psychology; Nursing; Nursing Research; Oncology; Oncology, Experimental; Original Article; Outpatient care facilities; Outpatients - statistics & numerical data; Pain Medicine; Proportional Hazards Models; Rehabilitation Medicine; Retrospective Studies; Risk Factors; Toxicity; Young Adult
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-012-1524-6

Purpose As a result of the growing cancer incidence and the increasing trend towards chemotherapy treatment, a higher number of cancer outpatients ask for unplanned visits. This study aimed to describe the nature and magnitude of this phenomenon and to identify risk factors for repeated unplanned presentations and hospital admission. Methods Unplanned consultations (2,811) of 1,431 cancer patients who accessed our acute oncology clinic over a 2-year period were reviewed. Demographics, clinical variables and reason(s) for presentation were all recorded. Recurrent event survival analysis was used to evaluate the relation of potential predictors to the two outcome events repeated presentations and hospitalization. A stratified Cox proportional hazard model was used. Results Of 1,431 patients, 625 (43 %) received chemotherapy during the 90 days before the unplanned visit. Pain (27.7 %), fatigue (17.6 %), dyspnoea (13.8 %), fever (11.5 %) and gastrointestinal problems (31 %) were reported frequently. The time interval since the last chemotherapy was significantly related to the rate of repeated presentation. Two hundred and nine patients (7 %) were hospitalized after an unplanned presentation. Number of symptoms and selected toxicities, along with distance from the hospital, were all predictors for hospitalization. Conclusions The management of unscheduled presentations of cancer outpatients is becoming crucial to avoid inappropriate selection for hospital admission and interferences with the ordinary work plan, improving quality of oncology services.