Background: Previous studies have suggested that grade III/IV diarrhea is a common complication in colorectal cancer, occurring in 20% to 30% of patients receiving chemotherapy. In some of these patients, hospitalization for supportive care is often required. However, the impact that these hospitalized patients have on overall use of health care resources has not been quantified. In the present study, a cost of illness analysis was conducted to estimate the overall cost of patients with colorectal cancer who were hospitalized for supportive care secondary to severe diarrhea.
Methods: This was a retrospective cohort study consisting of patients with colorectal cancer that had received fluoropyrimidines, irinotecan or oxaliplatin (or a combination thereof) and had developed grade III or IV diarrhea that resulted in hospital admission for supportive care. Data collection included patient demographics, disease-related information and use of health care resources to manage the grade III/IV diarrhea event.
Results: Patients had a mean age of 64.2 years, and 32 of 63 (50.8%) were receiving adjuvant chemotherapy with a curative intent. The severe diarrhea developed after the first cycle of chemotherapy in 58% of the patients and contributed to a dose reduction, change or discontinuation of chemotherapy in 9.5%, 15.9% and 34.2% of patients, respectively. Overall, the median length of hospital stay was eight days (range one to 49 days) translating to a mean cost of $8,230 per patient (95% CI $6,519 to $9,942). The diarrhea successfully resolved in 54 of 63 patients (85.7%).
Conclusions: Severe diarrhea requiring hospital admission is a costly and potentially fatal complication of chemotherapy in colorectal cancer. The identification of predictive factors and the implementation of prophylactic measures could reduce the morbidity and mortality associated with diarrhea.