Hospital Admission Less than 30 Days after Chemotherapy: Results from a Chemotherapy-Specific Morbidity and Mortality Conference in Gynecologic Oncology

Abstract

Introduction: Morbidity and Mortality (M&M) rounds can identify adverse events and improve patient safety however adoption in cancer centers is not routine. Herein we report the results of a chemotherapy-specific gynecologic oncology M&M rounds and identify reasons for hospital admission < 30 days after chemotherapy treatment. Methods: Between July 2014 and April 2016, all admissions < 30 days from chemotherapy administration were prospectively collected along with clinical data. Admissions were described and classified as planned or unplanned and as associated with chemotherapy or with underlying disease. Results: 585 patients were admitted, 78% of whom had ovarian cancer and 43% of whom had recurrent disease. Overall, 47% of admissions were unplanned and these were significantly longer than planned admissions (5.6 vs. 2.4 days, p = 0.0003). Of unplanned admissions, 43% were due to chemotherapy, and 57% were due to disease burden. 74% of patients had received >1 prior line of chemotherapy, and 22% were on clinical trial. The most common causes of unplanned admission were nausea, vomiting or failure to thrive (28.9%), fever (17.9%) and small bowel obstruction (19.9%). Conclusions: There is a high rate of unplanned admission < 30 days after chemotherapy and patients with ovarian cancer and recurrent disease are at the highest risk. This information can be used to counsel patients about complications of chemotherapy and to improve supportive management. M&M conferences surrounding unplanned admissions after chemotherapy may help guide therapy, encourage best supportive care, and prompt re-evaluation of treatment goals in heavily pretreated patients with recurrent.