Severe chemotherapy-induced diarrhea in patients with colorectal cancer: a cost of illness analysis

Background: Diarrhea is common with many types of chemotherapy and can have a major impact on maintaining dose intensity and treatment effectiveness, and on overall health care resource consumption. In this study, a cost of illness analysis was conducted to estimate the overall economic impact of grade III/IV diarrhea in patients with colorectal cancer receiving adjuvant or palliative chemotherapy. Methods: This was a retrospective cohort study of patients with colorectal cancer who had received fluoropyrimidines, irinotecan or oxaliplatin ( or a combination of these) and had developed grade III or IV diarrhea. Data collection included patient demographics, disease-related information and healthcare resource utilization to manage the grade III/IV diarrhea event ( n= 96). Results: Grade III/ IV diarrhea developed after the first cycle of chemotherapy in 54.2% of patients and was responsible for a median dose reduction and delay of 20% and 7 days, respectively. Overall, 31 of 96 patients (32.3%) required a hospital admission for supportive care with an 8- day median length of stay ( range 2 to 28 days). When the economic impact of the grade III/IV diarrhea was quantified, the mean cost was Can $2559 per patient ( 95% CI: $1665 to 3453). A logistic regression analysis identified grade IV diarrhea ( OR 11.2; P< 0.001) and severe diarrhea developing after the first chemotherapy cycle ( OR 3.1; P= 0.051) as being significantly associated with patient hospitalization. Conclusions: Grade III/IV diarrhea is a debilitating and costly complication of chemotherapy in colorectal cancer. Effective interventions that prevent the development of severe diarrhea need to be identified to save health-care costs and reduce patient morbidity.