Researchers have identified a significant burden of adverse events across the cancer care continuum, including preventable or mitigable events, according to a study published in Cancer (online August 17, 2017; doi:10.1002/cncr.30916).
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Current studies in clinical oncology often share a focus on patient safety. However, the focus tends to be on treatment-related toxicities, which hinders the ability to measure adverse events across cancer care.
Allison Lipitz-Snyderman, PhD, Memorial Sloan Kettering Cancer Center (New York, NY), and colleagues designed a study to assess the nature and extent of adverse events among patients with cancer across inpatients and outpatient settings. Researchers used a retrospective cohort of 400 adult patients (representing 133,358 days of follow-up) who were selected by stratified random sampling and exhibited breast (n = 128), colorectal (n = 136), or lung cancer (n = 136). Patients were treated at a comprehensive cancer center in 2012.
Candidate adverse events—injuries that were identified as a direct result of medical care—were recorded by trained nurse reviewers over a 1 year period from medical records and safety-reporting databases. Subsequently, physicians determined the adverse event harm severity and the chances of preventability and harm mitigation.
A total of 304 adverse events were identified, resulting in an overall rate of 2.3 events per 1000 patient days (91.2 per 1000 inpatient days, 0.9 per 1000 outpatient days). Authors of the study reported that 34% of the patients had at least one adverse event (95% CI, 29%-39%), and 16% of the patients had at least one preventable or mitigable adverse events (95% CI, 13%-20%).
Rates of adverse events for patients with breast cancer were lower than rates for patients with colorectal or lung cancer (P ≤ .001).
The rate of preventable or mitigable adverse events was 0.9 per 1000 patient days. Authors acknowledged that 6% of adverse events and 4% of preventable adverse events resulted in serious harm, among those including lymphedema, abscess, and renal failure.
Author concluded that a heavy burden of adverse events, including preventable or mitigable events, exist among patients being treated for breast, colorectal, and lung cancer. “Future research should examine risk factors and improvement strategies for reducing [this] burden,” they wrote.—Zachary Bessette
