title: Estimating the cost of illness in colorectal cancer patients who were hospitalized for severe chemotherapy-induced diarrhea.
abstract: BACKGROUND
  Previous studies have suggested that grade III/IV diarrhea is a common complication in colorectal cancer, occurring in 20% to 30% of patients receiving chemotherapy. In some of these patients, hospitalization for supportive care is often required. However, the impact that these hospitalized patients have on overall use of health care resources has not been quantified. In the present study, a cost of illness analysis was conducted to estimate the overall cost of patients with colorectal cancer who were hospitalized for supportive care secondary to severe diarrhea.
  
  
  METHODS
  This was a retrospective cohort study consisting of patients with colorectal cancer that had received fluoropyrimidines, irinotecan or oxaliplatin (or a combination thereof) and had developed grade III or IV diarrhea that resulted in hospital admission for supportive care. Data collection included patient demographics, disease-related information and use of health care resources to manage the grade III/IV diarrhea event.
  
  
  RESULTS
  Patients had a mean age of 64.2 years, and 32 of 63 (50.8%) were receiving adjuvant chemotherapy with a curative intent. The severe diarrhea developed after the first cycle of chemotherapy in 58% of the patients and contributed to a dose reduction, change or discontinuation of chemotherapy in 9.5%, 15.9% and 34.2% of patients, respectively. Overall, the median length of hospital stay was eight days (range one to 49 days) translating to a mean cost of $8,230 per patient (95% CI $6,519 to $9,942). The diarrhea successfully resolved in 54 of 63 patients (85.7%).
  
  
  CONCLUSIONS
  Severe diarrhea requiring hospital admission is a costly and potentially fatal complication of chemotherapy in colorectal cancer. The identification of predictive factors and the implementation of prophylactic measures could reduce the morbidity and mortality associated with diarrhea.
authors.affiliation: Cancer Care Ontario, 429 Danforth Avenue, Toronto, Ontario 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: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics*; D017281:Cost of Illness; D003967:Diarrhea / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents