title: Treatment complexity: a description of chemotherapy and supportive care treatment visits in patients with advanced-stage cancer diagnoses.
abstract: OBJECTIVE
  Modern chemotherapy regimens are growing increasingly complex, involving lengthy outpatient infusions, and additional visits for supportive care. The treatment of advanced-stage patients is uniquely one of unremitting therapy and varying complexity. The study's purpose was to describe and quantify the dimensions of treatment complexity in terms of chemotherapy (CT) and supportive care (SC) visits.
  
  
  METHODS
  Electronic medical records for 121 subjects with stages III and IV cancer were reviewed. Visits were classified as SC and CT types, and actual hours and visit numbers were calculated for a 3-month treatment period. Analysis included descriptive and generalized linear modeling statistics.
  
  
  RESULTS
  Subjects ≥65 years spent fewer total hours (M = 18.17 h, SD = 10.17 h, p = 0.04), but experienced more total visits (M = 10.96 visits, SD = 4.65 visits, p = 0.02) than younger subjects. More than 71% of younger patients spent two or more hours per chemotherapy visit, compared to 41.7% of older patients (p = 0.001). Older subjects were more likely to have a SC visit (p = 0.03), but did not differ from younger subjects in SC visit numbers (p = 0.3) or hours (p = 0.6). Females averaged 3.81 more total hours (M = 22. 61 h, SD = 11.06 h, p = 0.055) and had more total visits (M = 10.80 visits, SD = 3.71, p = 0.02) than males. By visit type, women spent twice the hours undergoing SC than males (M = 3.3 vs. 1.5 h, p = 0.051), but genders did not differ in CT visit hours or average length. By diagnosis, colon/esophageal subjects spent more hours in CT visits (M = 21.90 h, SD = 8.60 h, p < 0.01), and lung subjects trended toward spending more hours in SC visits (M = 4.80 h, SD = 8.23 h, p < 0.06).
  
  
  CONCLUSIONS
  Advanced-stage cancer patients differed in visit types, hours, and treatment length undergoing CT and SC visits. Age, gender, and diagnosis explained the differences, and this study adds new understanding to the phenomenon of treatment complexity.
authors.affiliation: School of Nursing, Fairfield University, 1073 North Benson Road, Fairfield, CT, 06824, USA. csumpio@fairfield.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sumpio
authors.affiliation: School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA.
authors.forename: M Tish
authors.initials: MT
authors.lastname: Knobf
authors.affiliation: School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA.
authors.forename: Sangchoon
authors.initials: S
authors.lastname: Jeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009819:Office Visits / Q000706:statistics & numerical data; D010045:Outpatients; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D012944:Social Support; D013997:Time Factors
keywords: Advanced-stage cancer; Chemotherapy treatment; Supportive care; Treatment complexity