title: Emergency room visits and hospital admission rates after curative chemotherapy for breast cancer.
abstract: OBJECTIVE
  Curative chemotherapy for breast cancer is associated with significant toxicities including emergency room (ER) visits and hospital admissions (HAs), events that are underreported in clinical trials. This study examined the reasons for, and factors associated with, ER visits and HA after curative chemotherapy for breast cancer in a tertiary Ontario hospital.
  
  
  METHODS
  A retrospective study of all patients who completed at least one cycle of curative chemotherapy for breast cancer in 2011 and 2012 was conducted. We recorded ER visits and HAs within 30 days of any chemotherapy. We collected demographics, comorbidities, surgical data, tumor characteristics, chemotherapy type and cycles, and use of granulocyte colony-stimulating factors (G-CSF).
  
  
  RESULTS
  A total of 149 patients underwent curative chemotherapy. Mean age was 58.6 years. Adjuvant chemotherapy was received by 85% of patients and G-CSF by 88.6%. At least one ER visit occurred in 53% of patients, and 13% required HA. The most common causes of ER visits were fever without neutropenia (23.3%), pain (12.8%), and febrile neutropenia (9%). Stage of breast cancer was the only factor statistically significantly associated with ER visits (P = .045); tumor size (P = .019), adjuvant chemotherapy (P = .045), and lower number of chemotherapy cycles (P = .005) were significantly associated with HA.
  
  
  CONCLUSIONS
  Future research should focus on identifying the patient, provider, and health system factors associated with ER visits and HAs after chemotherapy for breast cancer, to minimize them and lessen the burden on the health care system.
authors.affiliation: Cancer Centre of Southeastern Ontario at Kingston General Hospital; Queen's University; and Kingston General Hospital Clinical Research Centre, Kingston, Ontario, Canada.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Pittman
authors.affiliation: Cancer Centre of Southeastern Ontario at Kingston General Hospital; Queen's University; and Kingston General Hospital Clinical Research Centre, Kingston, Ontario, Canada.
authors.forename: Wilma M
authors.initials: WM
authors.lastname: Hopman
authors.affiliation: Cancer Centre of Southeastern Ontario at Kingston General Hospital; Queen's University; and Kingston General Hospital Clinical Research Centre, Kingston, Ontario, Canada matesm@kgh.kari.net.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Mates
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000139:chemically induced; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects* / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control; D010146:Pain / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor