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Unplanned acute care utilization during cancer treatment can negatively impact patient quality of life, healthcare costs and clinical outcomes. Our objective was to evaluate risk factors for unplanned ambulatory acute care clinic (AACC) utilization in gynecological oncology patients receiving radiotherapy (RT).

This was a retrospective review of gynecological cancer patients treated at our institution between August 1, 2021, and January 31, 2022. Patients were divided into 2 cohorts: those receiving concurrent chemoradiation regimens (CCR) and those receiving RT alone. Baseline socio-demographic data, as well as clinical and treatment characteristics, were extracted from medical records. Data pertaining to unplanned visits to our AACC were also collected, including number of visits during treatment, chief complaint, and interventions performed. Descriptive statistics summarized the study population. Student's t-test and chi-squared test were used for comparisons of continuous and categorical variables, respectively.

RT was delivered to 180 gynecological cancer patients within the time period, of which 42 received CCR (23.3%) and 138 (76.7%) received RT alone. PORTEC-3 for endometrial cancer was the most common CCR regimen (59.5%), followed by weekly cisplatin/RT for cervix cancer (33.3%). CCR patients had higher rates of unplanned AACC utilization compared to those receiving RT alone (54.8% vs. 18.8%, p<0.001) and visited more frequently during treatment (3.1 visits/patient vs. 1.4 visits/patient; p=0.005). CCR patients most commonly presented with dehydration requiring an intervention with IV fluids (33.6% of visits), whereas RT only patients presented with questions surrounding symptom management requiring patient education (21.4% of visits). CCR patients who visited the AACC had higher rates of Psychosocial Oncology referrals (60.9% vs. 5.3%; p<0.001) and were more likely to be single (43.5% vs. 10.5%; p=0.019) compared to CCR patients who did not visit the AACC. CCR patients with unplanned AACC utilization had significantly more treatment interruptions (52.2%) compared to those who did not visit the AACC (15.8%, p=0.014) and compared to RT alone patients who did present to the AACC (7.7%, p<0.001). There were no associations between disease site, age, nor distance to the cancer centre and unplanned AACC utilization.

Gynecological oncology patients undergoing CCR are at increased risk for unplanned acute care utilization. Psychosocial referrals, being single and treatment interruptions were significantly higher in CCR patients utilizing the AACC. Targeted strategies to better meet the supportive care and psychosocial needs of this population are required.