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Monitoring acute care utilization (ACU) during adjuvant chemotherapy for early breast cancer (EBC) as a measure of quality.

220 Background: Serious chemotherapy associated (CA) toxicities resulting in ACU are a concern when administering adjuvant chemotherapy for EBC. Monitoring ACU during adjuvant chemotherapy may serve as a measure of quality of cancer care delivery. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls.


METHODS
All EBC patients diagnosed 01/07 - 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU.


RESULTS
ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs. 9.1%, p<.001) and CA (30.7% vs. 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs. 1.2%,p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only (see Table).


CONCLUSIONS
Serious chemotherapy associated toxicity resulting in ACU is common among EBC patients receiving chemotherapy. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs and improve quality of care. [Table: see text].