This study examined the risk of emergency hospital admission following the administration of adjuvant chemotherapy to patients with early breast cancer in NSW in 2008-2012.
Linked NSW Cancer Registry (NSWCR) and NSW Admitted Patient Data Collection data were used in this study. Women aged ≥18 years diagnosed with non-metastatic breast cancer in NSW in 2008-2012 were identified and included if they started adjuvant cytotoxic chemotherapy within 6 months of diagnosis as recorded in the NSWCR. Patients were grouped by index chemotherapy protocol as doxorubicin/cyclophosphamide 3-weekly (AC), docetaxel/ doxorubicin/cyclophosphamide (TAC), docetaxel/cyclophosphamide (TC), fluorouracil/epirubicin/ cyclophosphamide followed by docetaxel (FEC-D), fluorouracil/epirubicin/cyclophosphamide (FEC-100 and FEC-90), docetaxel/carboplatin/trastuzumab (TCH) and doxorubicin/cyclophosphamide 3-weekly followed by paclitaxel 3-weekly (AC+PAC). Rates of emergency hospital admissions occurring within 6 weeks of chemotherapy initiation were compared between patient groups. Logistic regression was used to calculate odds ratios (OR) with 95% CIs for emergency admission.
Of the 4,075 women included in the analyses, 17.2% (n=699) had an emergency hospital admission within 6 weeks of chemotherapy initiation. The most common principal diagnoses at admissions were neutropenia (43.8%), followed by infections (7.4%). The highest hospitalisation rates were detected for TCH (29.8%) and TC (27.5%). After adjustment for age at diagnosis, node positivity, TNM stage and surgery type, women who used TCH or TC had almost 2-fold risk of emergency hospital admission compared with those who used AC (OR 1.97, 95%CI 1.42-2.75 and OR 1.93, 95%CI 1.49-2.49, respectively).
Emergency hospitalisations following adjuvant chemotherapy for early breast cancer were relatively common, with highest rates detected for those who received TCH or TC. Further examination of reasons for admissions is needed to inform appropriate actions to improve patient safety.