Mortality within 30 days of systemic anticancer therapy at a tertiary cancer centre: assessing the safety and quality of clinical care.

Aims: Thirty-day mortality has been proposed to be a useful indicator of avoidable harm to patients from systemic anticancer therapies (SACT). As a quality assurance tool, we assessed the 30-day mortality rate at Auckland City Hospital and compared this with international standards.

Methods: Clinical characteristics and treatment details of medical oncology patients who died within 30 days of SACT from October 2014-September 2015 were collected and compared with data from a similar series performed from October 2008-September 2009. SACT was limited to chemotherapy or biologic agents.

Results: From October 2014-September 2015, 1,965 patients received 2,145 treatment regimens. Forty-seven patients (2.2%) died within 30 days of SACT. Treatment was given with palliative intent in 42 patients (in 89%) and curative intent in five (11%). Mortality rates did not change with time (2.8% in 2009 vs 2.2% in 2015). Of the patient who died within 30 days, ECOG performance status at the time of chemotherapy was one in 16 patients (34.0%), two in nine patients (19.1%) and 3/4 in nine of the 47 patients (19.1%). All patients treated with curative intent had a PS of 0 or 1. Most patients who died within 30 days were on first- or second-line therapy (45 and 38% respectively). Two-thirds of patients with a PS of 3/4 were receiving first-line therapy. Approximately half the patients died during their first cycle of therapy (48.9%).

Conclusions: Our local 30-day mortality data compares favourably to international benchmarks of 5% and has not increased over time. Performance of similar studies locally and nationally should be undertaken to continue to assess and improve the quality of our patient care.