Emergency Department Visits for Treatment-Related Complications of Systemic Therapy and Radiotherapy
In a study reported in JAMA Oncology, Jairam et al found that emergency department visits for complications of systemic therapy or radiotherapy in patients with cancer increased at a 5.5-fold higher rate over 10 years compared with overall emergency department visits.
Study Details
The study involved a retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Between January 2006 and December 2015, there was a weighted total of 1.3 billion emergency department visits. Of these, 1.5 million visits were related to a complication of systemic therapy or radiotherapy for cancer. Among the 1.5 million emergency department visits for complications of systemic therapy or radiotherapy for cancer, patients had a mean age of 63.3 years and 53.2% of patients were female.
Complications and Cost
Treatment-related emergency department visits increased by a rate of 10.8% per year, compared with 2.0% for overall emergency department visits over the study period. Of treatment-related emergency department visits among patients with cancer, 90.9% resulted in admission to the hospital and 4.9% resulted in death during hospitalization. The most common and expensive complications diagnosed during the emergency department visits were neutropenia (8.9% of patients; total cost = $5.52 billion), sepsis (8.4% of patients; total cost = $11.21 billion), and anemia (7.7% of patients; total cost = $6.78 billion). Sepsis (odds ratio [OR] = 21.00, 95% confidence interval [CI] = 14.61–30.20), pneumonia (OR = 9.73, 95% CI = 8.08–11.73), and acute kidney injury (OR = 9.60, 95% CI = 7.77–11.85) were significant risk factors for inpatient admission.
Costs associated with the top 10 most common complications diagnosed at emergency department visits totaled $38 billion over the study period and accounted for 48% of the total financial burden of the study population.
The investigators concluded, “Emergency department visits for complications of systemic therapy or radiotherapy increased at a 5.5-fold higher rate over 10 years compared with overall emergency department visits. Neutropenia, sepsis, and anemia appear to be the most common complications; sepsis, pneumonia, and acute kidney injury appear to be associated with the highest rates of inpatient admission. These complications suggest that significant charges are incurred on emergency department visits.”
James B. Yu, MD, MHS, of the Department of Therapeutic Radiology, Yale University School of Medicine, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
