High Dropout & Early Deaths on Chemotherapy in Real World Sounds Alarm Bells: Audit from Department of Medical Oncology of a Tertiary Care Cancer Centre in South India

Background: Comprehensive data on early outcome of cancer management including treatment drop out, mortality, follow-up and survival, for all registered cases is scarce. Methods: From a prospectively maintained record system in the department of Medical Oncology, an audit was done for all patients registered in the calendar year 2015 for  diagnosis, treatment course, follow-up and vital status. We follow a system of outpatient clinic booked appointment and for patients who default, serial phone calls are made to counsel about compliance and give a next review date. Results: Of total 1173 cases registered, 73.5% had solid (n = 863), and 25.5% had hematological malignancies (n = 300). Median age was 48 (1 month – 85 years); 11% pediatric, 72% adults and 17% were elderly. Male to female ratio was 0.74:1. Five most common cancers were breast (27.7%), lymphoma (11.6%) acute leukemia (9.4%), esophago-gastric (9.2%), followed by ovarian and lung carcinoma, 7% each. Almost a quarter (28%) were lost to follow up (LTFU) on different treatment phases and another one third (33%) had died during the study period. Almost half of all deaths were for patients on chemotherapy with either curative or palliative intent. Significantly higher rate of LTFU was noted for patients’ age > 18 years, with solid malignancies and with longer distance (>100 kilometres) from hospital. Conclusion: Periodic audit is essential for effective functioning of any cancer treatment program. High rates of treatment defaults and early deaths on chemotherapy demands strengthening of counselling and supportive care services to improve overall outcomes. Keywords: audit, real world, outcomes, chemotherapy