“First, do no harm” is a fundamental element of health care and considered indistinguishable from the delivery of quality in health care. While cancer care has become more effective, it has also become more complex consequently increasing the risk for harm. We have assessed the extent and severity of treatment related adverse events in hospitalised cancer patients and elucidated how adverse events can be used as a measure of quality and safety in cancer care. All three studies are retrospective cohort studies, using the Global Trigger Tool to identify adverse events in hospitalised cancer patients.
We find that hospitalised cancer patients more often than other patients experience adverse events, but this is due to older age and longer length of stay rather than the cancer itself. Especially medication related harm and healthcare associated infections are safety hazards of concern to cancer patients. Patients dying in hospitals differ in several ways from a general hospitalised population and experience seven times the rate of severe adverse events. For nearly one in three deceased cancer patients an adverse event contributes to death. Despite strong recommendations limiting use of aggressive anticancer treatments for cancer patients near the end of life, we found that one third of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of their lives. Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events with twice the odds of having an adverse event contributing to death.
A thorough understanding of specific adverse events in cancer care is clearly warranted and can enhance of quality and patient safety in cancer care.
Paper I: Haukland, E.C., von Plessen, C., Nieder, C. & Vonen, B. (2017). Adverse events in hospitalised cancer patients; a comparison to a general hospital population. Acta Oncologica, 56(9), 1218-1223. Also available at https://hdl.handle.net/10037/13320.
Paper II: Haukland, E.C., Mevik, K., von Plessen, C., Nieder, C. & Vonen, B. (2019). Contribution of adverse events to death of hospitalised patients. BMJ Open Quality, 8(1), e000377. Also available at https://hdl.handle.net/10037/16039.
Paper III: Haukland, E.C., von Plessen, C., Nieder, C. & Vonen, B. Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end of life cancer care. (Submitted manuscript).