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Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department

BACKGROUND: There is increasing interest in unplanned care utilization among lung cancer patients and its evaluation should allow the identification of areas for quality improvement. Being a major priority for transformation in oncology, we aim to measure the risk and burden of unplanned care in a m...

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Autores principales: Sánchez, Juan C., Nuñez-García, Beatriz, Ruano-Ravina, Alberto, Blanco, Mariola, Martín-Vegue, Arturo Ramos, Royuela, Ana, Cantos, Blanca, Méndez, Miriam, Calvo, Virginia, Provencio, Mariano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483072/
https://www.ncbi.nlm.nih.gov/pubmed/37691863
http://dx.doi.org/10.21037/tlcr-23-48
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author Sánchez, Juan C.
Nuñez-García, Beatriz
Ruano-Ravina, Alberto
Blanco, Mariola
Martín-Vegue, Arturo Ramos
Royuela, Ana
Cantos, Blanca
Méndez, Miriam
Calvo, Virginia
Provencio, Mariano
author_facet Sánchez, Juan C.
Nuñez-García, Beatriz
Ruano-Ravina, Alberto
Blanco, Mariola
Martín-Vegue, Arturo Ramos
Royuela, Ana
Cantos, Blanca
Méndez, Miriam
Calvo, Virginia
Provencio, Mariano
author_sort Sánchez, Juan C.
collection PubMed
description BACKGROUND: There is increasing interest in unplanned care utilization among lung cancer patients and its evaluation should allow the identification of areas for quality improvement. Being a major priority for transformation in oncology, we aim to measure the risk and burden of unplanned care in a medical oncology department and identify factors that determine acute care. METHODS: This was an observational retrospective cohort study that included all lung cancer patients treated at Puerta de Hierro-Majadahonda University Hospital between January 1st 2016 and December 31st 2020. Data cut off: June 30th, 2021. The main objective was to assess the incidence of unplanned care, emergency department (ED) visits and unplanned hospital admissions, from the first visit to the medical oncology service and its potential conditioning variables, considering patient death as a competitive event. As secondary objectives, a description and a quality of unplanned care evaluation was carried out. RESULTS: A total of 821 lung cancer patients, all histologies and stages, were included (median follow-up: 32.8 months). Six hundred and eighty-one patients required consultation in the ED (82.9%), and 558 required an unplanned admission (68%). Eighty-six percent of ED consultations and 80.9% of unplanned hospital admissions were related to cancer or its treatment. The 1-year cumulative incidence for ED consultation and for unplanned hospital admission was 71.3% (95% CI: 67.8–74.5%) and 56.7% (95% CI: 53–60%), respectively. In the multivariable analysis, a higher tumor stage increased the risk of consultation in the ED, while a higher stage, Eastern Cooperative Oncology Group performance status (ECOG PS) 2 compared to ECOG PS 0, male sex, opioid or steroid use at first consultation increased the risk of unplanned admission. CONCLUSIONS: Our study shows that lung cancer patients have an extremely high demand for unplanned care. It is an early need and related to cancer in the majority of consultations and admissions and therefore a key issue for the management of oncology departments. We must optimize the follow-up of patients with a higher risk of unplanned care, advanced lung cancer or symptomatic patients, incorporating remote monitoring strategies and early interventions, as developing specific urgent care pathways for a better comprehensive cancer care.
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spelling pubmed-104830722023-09-08 Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department Sánchez, Juan C. Nuñez-García, Beatriz Ruano-Ravina, Alberto Blanco, Mariola Martín-Vegue, Arturo Ramos Royuela, Ana Cantos, Blanca Méndez, Miriam Calvo, Virginia Provencio, Mariano Transl Lung Cancer Res Original Article BACKGROUND: There is increasing interest in unplanned care utilization among lung cancer patients and its evaluation should allow the identification of areas for quality improvement. Being a major priority for transformation in oncology, we aim to measure the risk and burden of unplanned care in a medical oncology department and identify factors that determine acute care. METHODS: This was an observational retrospective cohort study that included all lung cancer patients treated at Puerta de Hierro-Majadahonda University Hospital between January 1st 2016 and December 31st 2020. Data cut off: June 30th, 2021. The main objective was to assess the incidence of unplanned care, emergency department (ED) visits and unplanned hospital admissions, from the first visit to the medical oncology service and its potential conditioning variables, considering patient death as a competitive event. As secondary objectives, a description and a quality of unplanned care evaluation was carried out. RESULTS: A total of 821 lung cancer patients, all histologies and stages, were included (median follow-up: 32.8 months). Six hundred and eighty-one patients required consultation in the ED (82.9%), and 558 required an unplanned admission (68%). Eighty-six percent of ED consultations and 80.9% of unplanned hospital admissions were related to cancer or its treatment. The 1-year cumulative incidence for ED consultation and for unplanned hospital admission was 71.3% (95% CI: 67.8–74.5%) and 56.7% (95% CI: 53–60%), respectively. In the multivariable analysis, a higher tumor stage increased the risk of consultation in the ED, while a higher stage, Eastern Cooperative Oncology Group performance status (ECOG PS) 2 compared to ECOG PS 0, male sex, opioid or steroid use at first consultation increased the risk of unplanned admission. CONCLUSIONS: Our study shows that lung cancer patients have an extremely high demand for unplanned care. It is an early need and related to cancer in the majority of consultations and admissions and therefore a key issue for the management of oncology departments. We must optimize the follow-up of patients with a higher risk of unplanned care, advanced lung cancer or symptomatic patients, incorporating remote monitoring strategies and early interventions, as developing specific urgent care pathways for a better comprehensive cancer care. AME Publishing Company 2023-08-28 2023-08-30 /pmc/articles/PMC10483072/ /pubmed/37691863 http://dx.doi.org/10.21037/tlcr-23-48 Text en 2023 Translational Lung Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Sánchez, Juan C.
Nuñez-García, Beatriz
Ruano-Ravina, Alberto
Blanco, Mariola
Martín-Vegue, Arturo Ramos
Royuela, Ana
Cantos, Blanca
Méndez, Miriam
Calvo, Virginia
Provencio, Mariano
Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
title Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
title_full Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
title_fullStr Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
title_full_unstemmed Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
title_short Patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
title_sort patterns and outcome of unplanned care in lung cancer patients: an observational study in a medical oncology department
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483072/
https://www.ncbi.nlm.nih.gov/pubmed/37691863
http://dx.doi.org/10.21037/tlcr-23-48
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