title: Severe chemotherapy-induced diarrhea in patients with colorectal cancer: a cost of illness analysis.
abstract: BACKGROUND
  Diarrhea is common with many types of chemotherapy and can have a major impact on maintaining dose intensity and treatment effectiveness, and on overall health care resource consumption. In this study, a cost of illness analysis was conducted to estimate the overall economic impact of grade III/IV diarrhea in patients with colorectal cancer receiving adjuvant or palliative chemotherapy.
  
  
  METHODS
  This was a retrospective cohort study of patients with colorectal cancer who had received fluoropyrimidines, irinotecan or oxaliplatin (or a combination of these) and had developed grade III or IV diarrhea. Data collection included patient demographics, disease-related information and healthcare resource utilization to manage the grade III/IV diarrhea event (n=96).
  
  
  RESULTS
  Grade III/IV diarrhea developed after the first cycle of chemotherapy in 54.2% of patients and was responsible for a median dose reduction and delay of 20% and 7 days, respectively. Overall, 31 of 96 patients (32.3%) required a hospital admission for supportive care with an 8-day median length of stay (range 2 to 28 days). When the economic impact of the grade III/IV diarrhea was quantified, the mean cost was Can 2559 dollars per patient (95%CI: 1665 to 3453 dollars). A logistic regression analysis identified grade IV diarrhea (OR 11.2; P<0.001) and severe diarrhea developing after the first chemotherapy cycle (OR 3.1; P=0.051) as being significantly associated with patient hospitalization.
  
  
  CONCLUSIONS
  Grade III/IV diarrhea is a debilitating and costly complication of chemotherapy in colorectal cancer. Effective interventions that prevent the development of severe diarrhea need to be identified to save health-care costs and reduce patient morbidity.
authors.affiliation: Cancer Care Ontario, 429 Danforth Ave, Suite 476, Toronto M4K 1P1, Canada. gdranit@ca.inter.net
authors.forename: George
authors.initials: G
authors.lastname: Dranitsaris
authors.forename: Jean
authors.initials: J
authors.lastname: Maroun
authors.forename: Amil
authors.initials: A
authors.lastname: Shah
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D017281:Cost of Illness; D003967:Diarrhea / Q000139:chemically induced*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged