title: Risk of unplanned visits for colorectal cancer outpatients receiving chemotherapy: a case-crossover study.
abstract: OBJECTIVE
  This study was conducted to evaluate the impact of chemotherapy on the risk of unplanned visit in a cohort of colorectal cancer outpatients. Chief complaints for unplanned visits and risk factors for hospital admission were also analyzed.
  
  
  METHODS
  Clinical data of 229 consecutive colorectal cancer patients who were unexpectedly presented to our acute oncology clinic between 2006 and 2009 were reviewed. A case-crossover statistical analysis was applied to study the association between exposure to chemotherapy (trigger event) and the occurrence of unplanned visit (acute outcome) in three time windows (7, 15, and 21 days from the closest previous chemotherapy treatment). Cox model was used to assess the risk factors for hospitalization.
  
  
  RESULTS
  There were 469 unplanned visits registered. Most of the patients had Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 (80 %) and advanced cancer stage (78 %). The majority of unplanned visits (72 %) occurred within 30 days since last chemotherapy. The most frequent presenting complaints were pain, fatigue, and anorexia. The two time windows associated with higher risk of visit were 15 and 21 days from last treatment, both for early (odds ratio [OR] 3.8, CI 1.4-10.2 and OR 3.8, CI 1.4-10.2) and advanced disease stage (OR 1.71, CI 1-2.9 and OR 3, CI 1.5-5.9). Of the unplanned visits, 10 % resulted in hospital admission. Presenting with multiple symptoms and with deteriorated PS were both predictors for hospitalization.
  
  
  CONCLUSIONS
  Chemotherapy exposition triggers the need for unplanned visits over the second and third week after treatment. The prompt and effective management of unexpected events may be cost- and time-saving and reduce pressure on oncology services.
authors.affiliation: Department of Oncology, University Hospital "S. Maria della Misericordia", Udine, Italy, foltranluisa@libero.it.
authors.forename: Luisa
authors.initials: L
authors.lastname: Foltran
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.forename: Federica Edith
authors.initials: FE
authors.lastname: Pisa
authors.forename: Paola
authors.initials: P
authors.lastname: Ermacora
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pella
authors.forename: Emiliana
authors.initials: E
authors.lastname: Iaiza
authors.forename: Elena
authors.initials: E
authors.lastname: Poletto
authors.forename: Stefania Eufemia
authors.initials: SE
authors.lastname: Lutrino
authors.forename: Micol
authors.initials: M
authors.lastname: Mazzer
authors.forename: Mariella
authors.initials: M
authors.lastname: Giovannoni
authors.forename: Giovanni Gerardo
authors.initials: GG
authors.lastname: Cardellino
authors.forename: Fabio
authors.initials: F
authors.lastname: Puglisi
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Fasola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000453:epidemiology*; D018592:Cross-Over Studies; D005260:Female; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010347:Patient Care Planning; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents
references.citation: Support Care Cancer. 2005 May;13(5):303-10
references.pmid: 15729552
references.citation: Value Health. 2002 Jan-Feb;5(1):35-43
references.pmid: 11873382
references.citation: Lancet. 2005 Jan 1-7;365(9453):82-93
references.pmid: 15639683
references.citation: Am J Epidemiol. 1991 Jan 15;133(2):144-53
references.pmid: 1985444
references.citation: Support Care Cancer. 2011 Jul;19(7):963-9
references.pmid: 20499108
references.citation: J Clin Oncol. 2009 Dec 20;27(36):6191-8
references.pmid: 19917849
references.citation: J Clin Oncol. 2011 Jul 1;29(19):2683-8
references.pmid: 21606431
references.citation: J Natl Cancer Inst. 2006 Aug 16;98(16):1108-17
references.pmid: 16912263
references.citation: Curr Opin Oncol. 1998 Jul;10(4):297-301
references.pmid: 9702396
references.citation: Eur J Cancer. 2013 Apr;49(6):1374-403
references.pmid: 23485231
references.citation: Ann Emerg Med. 2013 Apr;61(4):427-437.e5
references.pmid: 23290526
references.citation: Stat Methods Med Res. 2009 Feb;18(1):53-65
references.pmid: 18765504
references.citation: Eur J Cancer. 2012 Dec;48(18):3328-34
references.pmid: 22683169
references.citation: Support Care Cancer. 2008 Jun;16(6):567-75
references.pmid: 18322707
references.citation: Support Care Cancer. 2005 Jul;13(7):515-21
references.pmid: 15678347
references.citation: Curr Opin Support Palliat Care. 2009 Mar;3(1):50-4
references.pmid: 19365161
references.citation: Support Care Cancer. 2004 Sep;12(9):626-33
references.pmid: 15064936
references.citation: Cancer. 2004 Aug 15;101(4):851-7
references.pmid: 15305419
references.citation: Cancer. 2008 Jan 15;112(2):284-92
references.pmid: 18041060
references.citation: Support Care Cancer. 2013 Feb;21(2):397-404
references.pmid: 22722887
references.citation: Oncol Nurs Forum. 2001 Apr;28(3):465-70
references.pmid: 11338755
references.citation: Tumori. 2007 Jul-Aug;93(4):392-7
references.pmid: 17899871
references.citation: Eur J Oncol Nurs. 2012 Apr;16(2):115-23
references.pmid: 21555246
references.citation: Oncologist. 2000;5(5):353-60
references.pmid: 11040270
references.citation: J Oncol Pract. 2011 May;7(3 Suppl):25s-30s
references.pmid: 21886516
references.citation: Annu Rev Public Health. 2000;21:193-221
references.pmid: 10884952
references.citation: J UOEH. 2005 Dec 1;27(4):359-65
references.pmid: 16358929
references.citation: Support Care Cancer. 2004 Apr;12(4):274-7
references.pmid: 14735338
references.citation: BMC Cancer. 2011 Jun 15;11:250
references.pmid: 21676243
references.citation: Cancer. 2002 Jul 1;95(1):155-63
references.pmid: 12115329
references.citation: Eur J Cancer. 2008 Jul;44(10):1345-89
references.pmid: 18280139
references.citation: Ann Oncol. 2008 Dec;19(12):1985-91
references.pmid: 18632721
references.citation: Clin Transl Oncol. 2007 Dec;9(12):784-8
references.pmid: 18158982