Abstract
Introduction
Older patients with cancer often require acute care treatment through emergency department
(ED) visits and hospitalizations. This study investigates acute care utilization through
ED visits and hospitalizations during treatment and in the two years following the
completion of primary treatment for early stage breast cancer (EBC) in women aged
65 and older.
Materials and Methods
A retrospective analysis including descriptive statistics, univariate analysis, and
relative risk analysis of 256 women with EBC was performed through medical record
review of demographics, comorbidities, disease characteristics, treatment details,
and causes of hospitalizations and ED visits.
Results
Both hospitalizations and ED visits were significantly more frequent for patients
in the post-primary treatment period compared to during treatment (hospitalizations:
22% post-primary treatment vs 13% during treatment, 95% confidence interval [CI] of
true difference = 2.5%-15.5; ED visits: 21% post-primary treatment vs 10% during treatment,
95% CI of true difference = 4.8%–17.2%). Both hospitalizations (79% versus 32%, 95%
CI of true difference = 28.7%–65.3%) and ED visits (42% versus 12%, 95% CI of true
difference = 9.1%–50.9%) were more often breast cancer related during primary treatment
compared to following treatment. Following treatment, EBC related hospitalizations
were most often for disease progression (42%) and EBC related ED visits were most
often for post-systemic therapy complications (43%). Significant predictors for EBC
related hospitalizations in the two years following treatment included stage III disease
(relative risk [RR] = 8.77, 95% CI = 2.50–30.82), having underwent mastectomy (RR = 12.51,
95% CI = 2.91–53.78), and having received chemotherapy (RR = 3.95, 95% CI = 1.18–13.23).
However, chemotherapy does not appear to be a significant predictor for hospitalization
when controlling for stage III disease (RR = 2.22, 95% CI = 0.61–8.05), whereas stage
III disease remains a significant risk factor when controlling for chemotherapy (RR = 6.09,
95% CI = 1.58–23.52).
Discussion
Our findings suggests that stage III disease, undergoing mastectomy, and chemotherapy
treatment predict higher likelihood of EBC related hospitalization following primary
treatment in older EBC patients, with stage III disease likely the strongest risk
factor.
Keywords
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Article info
Publication history
Published online: January 18, 2023
Accepted:
January 3,
2023
Received in revised form:
November 23,
2022
Received:
September 13,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
