Many studies focus on treatment-related toxicities, but limited data are available on the frequency, spectrum, and preventability of adverse events (AEs) across cancer care. The retrospective, cohort CHARM (Cancer Harm) study conducted manual reviews of medical records and reports from local databases to assess the nature and extent of AEs in patients with cancer. The researchers presented the study at the ASCO Annual Meeting. 

The cohort included 400 medical and surgical adult patients (at least 18 years old) who had breast (n = 128), colorectal (n = 136), or lung (n = 136) cancers who were receiving treatment at a comprehensive cancer center. Patient treatment began in 2012, and follow-up was conducted in both inpatient and outpatient settings for up to one year. 

The researchers identified 318 AEs (2.38 events per 1,000 patient-days), and 36% of patients had at least one AE (95% confidence interval = 31–40). Thirty-five percent of AEs were considered likely preventable, including hypomagnesemia and pressure ulcer, while 12% were considered likely unpreventable, such as anemia and mucositis. See Table for specific AEs associated with different cancers.

Using a multivariable analysis, the researchers found that the following patient demographics were associated with increased odds of an AE occurrence.

  • Hispanic/Latino ethnicity
  • Late-stage diagnosis
  • Reported medication allergy
  • Anticoagulants
  • Diabetes medications
  • A palliative care consultation
  • Surgery
  • Chemotherapy

The researchers concluded, “We identified a large number of AEs in this longitudinal cohort of patients with breast, colorectal, and lung cancers. The risk factors we identified can help target high-risk patients for quality improvement activities to reduce the occurrence of, or harm associated with, AEs in the inpatient and outpatient settings.”

Table. AEs Associated With Different Cancers
Cancer Number of Patient Cases Patients with at least one AE Number of AEs identified AEs with permanent harm,
requiring life sustaining intervention,
or resulting in death
AEs deemed likely preventable
Total 400 36% 318  5% 35% 
Breast cancer 128  23%  50  12%  18% 
Colorectal cancer  136  43%  139  4%  31% 
Lung cancer 136 40%  129  5%  45% 
      AEs = adverse event.