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Unplanned presentations of cancer outpatients: a retrospective cohort study

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Abstract

Purpose

As a result of the growing cancer incidence and the increasing trend towards chemotherapy treatment, a higher number of cancer outpatients ask for unplanned visits. This study aimed to describe the nature and magnitude of this phenomenon and to identify risk factors for repeated unplanned presentations and hospital admission.

Methods

Unplanned consultations (2,811) of 1,431 cancer patients who accessed our acute oncology clinic over a 2-year period were reviewed. Demographics, clinical variables and reason(s) for presentation were all recorded. Recurrent event survival analysis was used to evaluate the relation of potential predictors to the two outcome events repeated presentations and hospitalization. A stratified Cox proportional hazard model was used.

Results

Of 1,431 patients, 625 (43 %) received chemotherapy during the 90 days before the unplanned visit. Pain (27.7 %), fatigue (17.6 %), dyspnoea (13.8 %), fever (11.5 %) and gastrointestinal problems (31 %) were reported frequently. The time interval since the last chemotherapy was significantly related to the rate of repeated presentation. Two hundred and nine patients (7 %) were hospitalized after an unplanned presentation. Number of symptoms and selected toxicities, along with distance from the hospital, were all predictors for hospitalization.

Conclusions

The management of unscheduled presentations of cancer outpatients is becoming crucial to avoid inappropriate selection for hospital admission and interferences with the ordinary work plan, improving quality of oncology services.

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Acknowledgments

We acknowledge and deeply thank Mrs. Paola Costantini, Mrs. Manuela De Apollonia and Mrs. Raffaela Donato for their generous assistance with study coordination, and all the other nurses at the Department of Medical Oncology, University Hospital, Udine, Italy, who contributed to data collection. This study was in part presented as oral communication at the 2011 MASCC Annual Meeting, Athens, Greece.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Oncology, University Hospital “S. Maria della Misericordia”, Udine, Italy

    G. Aprile, A. Follador, L. Foltran, M. Mazzer, S. Lutrino, C. S. Sacco, M. Mansutti & G. Fasola

  2. Institute of Hygiene and Clinical Epidemiology, University Hospital “S. Maria della Misericordia”, Udine, Italy

    F. E. Pisa

  3. Department of Oncology, Hospital “San Antonio”, San Daniele del Friuli, Udine, Italy

    F. De Pauli

  4. Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Piazzale S. Maria della Misericordia 15, 33100, Udine, Italy

    G. Aprile

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  1. G. Aprile
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  2. F. E. Pisa
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  3. A. Follador
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  10. G. Fasola
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Correspondence to G. Aprile.

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Aprile, G., Pisa, F.E., Follador, A. et al. Unplanned presentations of cancer outpatients: a retrospective cohort study. Support Care Cancer 21, 397–404 (2013). https://doi.org/10.1007/s00520-012-1524-6

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  • DOI: https://doi.org/10.1007/s00520-012-1524-6

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