Highly Emetogenic Chemotherapy Still Contributes to Potentially Avoidable Adverse Events
The Centers for Medicare and Medicaid Services (CMS) implemented an oncology outcome measure to assess the quality of care and determine outpatient hospital payment (OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy). The measure assesses 30-day postchemotherapy rates of inpatient or emergency department (ED) events deemed “potentially avoidable” because of an association with any of the 10 CMS-defined toxicities: anemia, dehydration, diarrhea, fever, nausea, emesis, neutropenia, pain, pneumonia, or sepsis. Researchers sought to assess those events when linked to highly emetogenic chemotherapy (HEC) in patients treated with anthracycline plus cyclophosphamide (AC), carboplatin, or cisplatin. They presented the findings at the San Antonio Breast Cancer Symposium on December 7, 2018 (https://www.abstracts2view.com/sabcs18/view.php?nu=SABCS18L_602).
Researchers used a large electronic health record (EHR) database to identify HEC courses of therapy patients received between October 2012 and September 2017. They assessed inpatient or ED events within 30 days of chemotherapy administration when related to OP-35 toxicities. During the study, patients had 4,128 eligible courses of HEC, including AC (n = 2,304; median = 4 cycles); carboplatin (n = 1,721; median = 6 cycles), and cisplatin (n = 103; median = 4 cycles). The median age of patients taking each regimen was 55, 59, and 64 years, respectively. A quarter of patients experienced 30-day inpatient or ED events, including 22% with AC, 30% with carboplatin, and 23% with cisplatin. A CMS-defined toxicity was associated with 73%, 72%, and 76% of the events, respectively, “confirming that these are principal contributors to 30-day inpatient or ED use for patients receiving HEC,” according to the authors.
The top five AEs commonly associated with inpatient/ED events for AC, carboplatin, and cisplatin, respectively, were:
- Pain (53%, 49%, and 63%)
- Anemia (51%, 51%, and 38%)
- Fever (48%, 31%, and 38%)
- Neutropenia (46%, 27%, and 31%)
- Nausea or emesis (30%, 40%, and 25%)
Some patients had more than one toxicity associated with each inpatient or ED event. “The inpatient or ED rate may be understated because some events, particularly [in the] ED, may occur out of the network the EHR data covers,” the researchers noted.
Lower rates of fever and neutropenia and higher rates of nausea or emesis among patients receiving carboplatin may be because the study period preceded the 2017 addition of carboplatin area under the curve ≥ 4 to national guidelines as HEC requiring triplet antiemetic prophylaxis, according to the investigators.