Use of health-care services during chemotherapy for breast cancer.
OBJECTIVE
The authors analyse the effect of chemotherapy on the use of additional health-care resources and report the clinical and demographic factors associated with such use.


METHODS
In women with breast cancer, eligible to receive first-line (neo)-adjuvant or palliative chemotherapy, consultations with health-care practitioners (general practitioners [GPs] and specialists) and admissions to emergency department and to hospital were prospectively recorded. Differences were studied according to these clinical and demographic variables: age, tumour stage, performance status, weight, height, body mass index, surgery type, chemotherapy type, number of courses, comorbidity, marital status, educational level, social status and occupational status.


RESULTS
Among 268 patients, 124 (42.2%) required one or more non-protocol health-care encounters. 180 visits were generated (GP 23.3%, specialist 35.5%, emergency department admission 21.1%, hospital admission 8.3%, others 3.3% and more than one resource 8.3%). Of total consultations 150 (83.3%) were chemotherapy-related. The number of visits was higher in the first courses. Fever and infection were the most frequent reasons for consultation in all resources. The dependent variable: 'need for non-protocol health-care encounter in any course' was statistically associated with age (p=0.002) and marital status (p=0.021); no association was found with other variables. In multivariate analysis, age (p=0.001) and marital status (p=0.009) remained statistically significant. Younger and married patients consumed less extra health resources.


CONCLUSIONS
Many patients receiving chemotherapy consume health-care resources in addition to their routine visits, usually treatment-related. Patients consult less in the later courses. Older and unmarried women in particular need extra care during chemotherapy.
Servicio de Oncología Médica, Hospital Universitario Puerta del Mar, Avda. Ana de Viya 21, Cádiz, Spain. josem.baena.sspa@juntadeandalucia.es
José M
JM
Baena-Cañada
Sara
S
Estalella-Mendoza
Petra
P
Rosado-Varela
Inmaculada
I
Expósito-Álvarez
Macarena
M
González-Guerrero
María C
MC
Díaz-Blanco
Cristina
C
Cortés-Carmona
Patricia
P
Ramírez-Daffós
Esperanza
E
Arriola-Arellano
Antonio
A
Rueda-Ramos
Lourdes
L
Solana-Grimaldi
Encarnación
E
Benítez-Rodríguez
D000328:Adult; D000367:Age Factors; D000368:Aged; D000886:Anthropometry; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D003131:Combined Modality Therapy; D015897:Comorbidity; D004198:Disease Susceptibility; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000453:epidemiology; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009819:Office Visits / Q000706:statistics & numerical data; D010166:Palliative Care; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013030:Spain; D055815:Young Adult