28 Sep Many Patients Require Hospitalization During Chemotherapy
MedicalResearch.com Interview with:
Dr. Rebecca Prince MBBS
Clinical Research Fellow and first author and
Monika K. Krzyzanowska, MD MPH FRCPC
Medical Oncologist, Princess Margaret Cancer Centre, Associate Professor, Dept of Medicine and Institute of Health Policy, Management & Evaluation, University of Toronto
Senior Adjunct Scientist, Institute for Clinical Evaluative Sciences
Clinical Lead, Quality Care & Access, Systemic Treatment Program, Cancer Care Ontario Toronto, ON
Medical Research: What is the background for this study? What are the main findings?
Response: This study was inspired by our previous work using administrative data in which we found that a large proportion of patients receiving chemotherapy in routine practice were visiting the emergency department and being admitted to hospital. Our perception was that the frequency of these events was higher than expected but when we went to look what was expected, ie. how often were people ending up in hospital during treatment in clinic trials, this data was not readily available. This led us to perform a systematic review of the literature including a comparison of hospitalization rates between patients treated in clinical trials and patients in similar clinical scenarios treated in routine practice. We ended up focusing on metastatic lung cancer as that was one of the clinical scenarios where we were able to identify published data from both clinical trials and routine practice.
The main finding of our study is that hospitalizations are very common during chemotherapy. We compared patients with metastatic lung cancer being treated in routine practice and clinical trials and found that that approximately half (51%) of patients treated in routine practice were hospitalized during chemotherapy, compared to 16% of trial patients. We also found that very few clinical trials reported this information which is routinely collected during the trial.
Medical Research: What should clinicians and patients take away from your report?
Response: This study makes it clear that hospitalizations are very common in patients with metastatic lung cancer undergoing chemotherapy, but it is also likely that this is true for most patient populations undergoing chemotherapy treatment for other indications. Clinicians should discuss this with patients when making decisions regarding treatment. We may also need to evaluate our current models of supportive care for patients undergoing chemotherapy. Are we supporting our patients in the best possible way to minimize the risk of toxicity getting out of hand? Some hospitalizations may be preventable with early intervention. From the patient perspective, they need to understand this risk so they can work with their providers to identify symptoms early. For some patients, they may make different treatment decisions if one treatment is associated with higher risk of being hospitalized than another treatment.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: We were not able to determine why there is such a marked difference in hospitalization rates between routine practice and trial settings. Future research needs to investigate factors contributing to this difference in outcome and explore interventions to decrease hospitalizations during chemotherapy treatment. We also need to understand how patients value this information in their decision making process. For example, if the goal of treatment is to prolong survival or quality of life and there are two different treatment options but one is more likely to result in hospitalization, patients may make different decisions regarding which treatment to pursue. Lastly, we recommend that all clinical trials begin to report how often patients are hospitalized during chemotherapy treatment.
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Dr. Rebecca Prince MBBS (2015). Many Patients Require Hospitalization During Chemotherapy