Daily Patient-Reported Symptoms as Predictors of Unplanned Health Care Encounters During Chemotherapy: Longitudinal Observational Study.

Abstract

Purpose: Chemotherapy can cause symptoms that impair quality of life and lead to unplanned health care encounters (UHEs) such as emergency department visits and inpatient admissions. Collecting patient-reported symptom data between clinic visits can enable timely identification of symptoms. This observational study aimed to identify how daily individual symptoms are associated with UHE.

Methods: We recruited patients (n = 183) receiving cytotoxic chemotherapy for solid tumors into our 90-day study. Participants completed a modified version of the patient-reported outcome-Common Terminology Criteria for Adverse Events questionnaire assessing common chemotherapy symptoms daily, and UHE information was extracted from medical records. We fit a series of logistic generalized estimating equations to evaluate day-level associations between moderate-to-severe daily symptoms and the occurrence of UHE within 7 days.

Results: On days with moderate-to-severe symptom levels, the odds of having one or more UHE within 7 days were 4.53 times higher for vomiting (95% CI, 1.77 to 11.58; P = .002), 2.84 times higher for decreased appetite (95% CI, 1.94 to 4.17; P < .001), 2.5 times higher for shortness of breath (95% CI, 1.44 to 4.34; P = .001), 1.76 times higher for diarrhea (95% CI, 1.11 to 2.79; P = .02), 1.65 times higher for fatigue (95% CI, 1.20 to 2.26; P = .002), and 1.58 times higher for pain (95% CI, 1.01 to 2.48; P = .04) relative to days with no-to-mild levels of that symptom. After adjusting for days since study enrollment, the odds of UHE were 2.17 times higher on days with moderate-to-severe pain in the abdomen (95% CI, 1.31 to 3.58; P = .003). The odds of UHE within 7 days also increased significantly as the number of moderate-to-severe symptoms increased (P < .001).

Conclusion: Specific daily symptoms were associated with increased risk of subsequent UHE during chemotherapy. Interventional studies are needed to better understand whether daily remote monitoring of these symptoms can reduce UHE.