title: Toxicity-Related Factors Associated With Use of Services Among Community Oncology Patients.
abstract: Community oncology practices frequently manage chemotherapy-associated toxicities, which may disrupt treatment, impair quality of life, and induce unplanned service use. We sought to understand the patterns and correlates of unplanned health care service use among patients receiving first-cycle chemotherapy at five community-based ambulatory oncology practices.
  
  
  
  A survey study examined the dichotomous outcome of unplanned service use, defined as oncologist visits, emergency department visits, and hospitalizations, resulting from toxicity-related factors. Newly diagnosed patients with breast, lung, head and neck, or colorectal cancer or non-Hodgkin lymphoma were recruited during the first chemotherapy cycle. Before beginning the second cycle of chemotherapy, patients completed a questionnaire that measured unplanned service use and overall distress, plus severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problems, pain, fever and chills, extremity edema, and dyspnea on a 5-point scale (1, did not experience; 5, disabling). Medical record reviews captured chemotherapy doses, comorbid conditions, and supportive care interventions. Mixed-effects logistic regression was used to identify factors associated with unplanned service use, with random effects specified for each clinic.
  
  
  
  Among 106 patients (white, 98%; female, 74.5%; mean age ± standard deviation, 60 ± 11 years), frequently reported toxicities were pain, nausea, diarrhea, and constipation. Thirty-six patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported emergency department visits, and 8% reported hospitalizations. Factors significantly associated with unplanned service use were high patient-reported distress and receipt of colony-stimulating factor.
  
  
  
  Service use resulting from toxicity-related factors occurs frequently in community oncology settings. Monitoring toxicity patterns and outcomes can inform proactive symptom management approaches to reduce toxicity burden between scheduled visits.
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI joharr@umich.edu.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Harrison
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Stella
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: Beth
authors.initials: B
authors.lastname: LaVasseur
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Adams
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: Lauren
authors.initials: L
authors.lastname: Swafford
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Lewis
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: Kari
authors.initials: K
authors.lastname: Mendelsohn-Victor
authors.affiliation: University of Michigan; St Joseph Mercy Hospital Cancer Center, Ann Arbor; and Genesys Hurley Cancer Institute, Flint, MI.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D000072103:Oncologists / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents