A Prospective Audit of Inpatient Medical Oncology Consultation Patterns in a Tertiary Teaching Hospital in South Australia
Rohit Joshi1, Christopher Hocking1, Siobhan O’Neill2, Nimit Singhal3, Michelle Kee4 and Dorothy M. Keefe3
1Lyell McEwin Hospital, Adelaide, South Australia; 2Prince of Wales Hospital, Sydney, Australia; 3Royal Adelaide Hospital, Adelaide, South Australia; 4The Queen Elizabeth Hospital, Adelaide, South Australia
Abstract: Objectives: Given the expanding role of medical oncology practice, with increasing therapeutic options for those with advanced malignancy, we sought to document the population of patients receiving inpatient medical oncology consultation. The aim of the study was to document patterns of inpatient referral to medical oncology in order to better understand service needs. We looked to define the relative frequency of cancer types, stage and treatment recommendations.
Design: A large prospective clinical audit was undertaken between January 2005 and January 2007.
Settings: The audit was conducted at the Royal Adelaide Hospital, a major tertiary referral hospital.
Participants: During the two year study period 1,173 consecutive inpatient referrals for medical oncology consultations were included in this analysis.
Main Outcome Measures: Information was collected regarding patient demographics, referral unit, cancer diagnosis and stage, treatment recommendations and follow-up plans.
Results: The most common referral units were General Medicine (19.8%) and Thoracic medicine (15%). The most common primary sites of cancer were lung (22.6%), colorectal (14.9%), primary brain tumours (9.6%) and head and neck (9.3%). The clear majority of patients had Stage 4 disease (80%) and were thus incurable in most cases. Chemotherapy was recommended in 43.7% of patients, chemo-radiation in 12.6% of patients, radiotherapy alone in 16.9% of patients and best supportive care in 24.1% of patients.
Conclusions: This large prospective clinical audit defines the population of patients referred for inpatient medical oncology consultation at our tertiary hospital. Cancer patients are being cared for by a wide variety of non-cancer specialists. The majority of patients have advanced, non-curable disease but anticancer therapy is provided to most with the intention of prolonging survival and maintaining quality of life.
Keywords: Inpatient consultations, medical oncology, cancer treatment, chemotherapy, hospital consultation.