Preventable and mitigable adverse events in cancer care: Measuring risk and harm across the continuum Journal Article


Authors: Lipitz-Snyderman, A.; Pfister, D.; Classen, D.; Atoria, C. L.; Killen, A.; Epstein, A. S.; Anderson, C.; Fortier, E.; Weingart, S. N.
Article Title: Preventable and mitigable adverse events in cancer care: Measuring risk and harm across the continuum
Abstract: BACKGROUND: Patient safety is a critical concern in clinical oncology, but the ability to measure adverse events (AEs) across cancer care is limited by a narrow focus on treatment-related toxicities. The objective of this study was to assess the nature and extent of AEs among cancer patients across inpatient and outpatient settings. METHODS: This was a retrospective cohort study of 400 adult patients selected by stratified random sampling who had breast (n = 128), colorectal (n = 136), or lung cancer (n = 136) treated at a comprehensive cancer center in 2012. Candidate AEs, or injuries due to medical care, were identified by trained nurse reviewers over the course of 1 year from medical records and safety-reporting databases. Physicians determined the AE harm severity and the likelihood of preventability and harm mitigation. RESULTS: The 400-patient sample represented 133,358 days of follow-up. Three hundred four AEs were identified for an overall rate of 2.3 events per 1000 patient days (91.2 per 1000 inpatient days and 0.9 per 1000 outpatient days). Thirty-four percent of the patients had 1 or more AEs (95% confidence interval, 29%-39%), and 16% of the patients had 1 or more preventable or mitigable AEs (95% confidence interval, 13%-20%). The AE rate for patients with breast cancer was lower than the rate for patients with colorectal or lung cancer (P ≤.001). The preventable or mitigable AE rate was 0.9 per 1000 patient days. Six percent of AEs and 4% of preventable AEs resulted in serious harm. Examples included lymphedema, abscess, and renal failure. CONCLUSIONS: A heavy burden of AEs, including preventable or mitigable events, has been identified. Future research should examine risk factors and improvement strategies for reducing their burden. Cancer 2017;123:4728-4736. © 2017 American Cancer Society. © 2017 American Cancer Society
Keywords: adult; middle aged; retrospective studies; major clinical study; cancer staging; follow up; follow-up studies; antineoplastic agent; neoplasm; neoplasms; colorectal cancer; infection; breast cancer; mucosa inflammation; thrombocytopenia; antineoplastic combined chemotherapy protocols; incidence; cohort analysis; risk factors; lung cancer; kidney failure; medical record review; oncology; retrospective study; risk factor; risk assessment; lymphedema; hypokalemia; cancer center; hospitalization; disease severity; drug surveillance program; total quality management; cardiovascular disease; medical research; patient safety; medical oncology; outpatient; clostridium difficile infection; urogenital tract disease; neurologic disease; gastrointestinal disease; medical error; medical errors; metabolic disorder; adverse drug reaction; hematologic disease; vascular disease; respiratory tract disease; prevention and control; quality improvement; abscess; adverse events; harm reduction; humans; prognosis; human; male; female; priority journal; article; drug-related side effects and adverse reactions; harm; malignant neoplasm
Journal Title: Cancer
Volume: 123
Issue: 23
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2017-12-01
Start Page: 4728
End Page: 4736
Language: English
DOI: 10.1002/cncr.30916
PUBMED: 28817180
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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MSK Authors
  1. David G Pfister
    249 Pfister
  2. Andrew Saul Epstein
    69 Epstein
  3. Aileen Killen
    12 Killen
  4. Coral Lynn Atoria
    49 Atoria