title: Chemotherapy-related hospitalization among community cancer center patients.
abstract: OBJECTIVE
  To describe the frequency, nature, trends, predictors, and outcomes of chemotherapy-related hospitalizations (CRHs) among a nonselected population of cancer patients treated at a community cancer center, and to explore the feasibility of implementing continuous quality improvement methodologies in routine oncology practice.
  
  
  METHODS
  We conducted a prospective cohort study of consecutive adult cancer patients who received chemotherapy at a community cancer center January 2003 to December 2006. Demographic, comorbidity, diagnosis, treatment, and laboratory data were collected via medical record abstraction. Hospitalizations were classified as chemotherapy related or unrelated by a multidisciplinary panel. Patients who experienced CRHs were compared with those who did not. Using a randomly sampled subset of cases and controls, we built a logistic regression model to identify independent predictors of CRH.
  
  
  RESULTS
  Of 2,068 chemotherapy recipients, 179 (8.7%) experienced 262 CRHs. Most hospitalizations were not chemotherapy related (73.7%). The mean monthly rate of CRH was 1.5%, the median length of stay was 5 days, the most common type of CRH was gastrointestinal (46.1%) followed by infectious (31.4%), and 0.9% of chemotherapy recipients had a fatal CRH. Significant predictors of CRH included having a comorbidity score of 3-4 versus 0 and having a higher creatinine level.
  
  
  CONCLUSIONS
  Although the vast majority of chemotherapy recipients did not experience a CRH, these events were, unfortunately, not without serious consequences. Care should be taken when offering chemotherapy to patients with multiple comorbid conditions. Systematic efforts to monitor toxicity can lead directly to improvements in quality of care.
authors.affiliation: Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA. michael_hassett@dfci.harvard.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: Suzana
authors.initials: S
authors.lastname: Brozovic
authors.forename: James E
authors.initials: JE
authors.lastname: Stahl
authors.forename: Joel H
authors.initials: JH
authors.lastname: Schwartz
authors.forename: Betty
authors.initials: B
authors.lastname: Maloney
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Jacobson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002173:Cancer Care Facilities; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents