ABSTRACT
Background: Hospitalizations during cancer treatment are common, can impact quality of life and the progress of the treatment. We aimed to investigate the main causes of hospitalizations and factors associated with in-hospital mortality for patients receiving chemotherapy. Methods: This retrospective study included patients (pts) with solid tumors, who received outpatient chemotherapy in the 30-day period before unplanned admission to a cancer center in Brazil, from February to December of 2021. Patients with COVID-19 diagnosis were excluded. We retrieved clinical and laboratory data from health records. Logistic regression univariable and multivariable models were performed to analyze the association of the variables and in-hospital mortality as dependent outcome. Results: 784 pts were included, median age at hospitalization was 60 (IQR 49-68), and 57% were female. Most patients had ECOG 0-1 (61%) and nearly 70% had metastatic disease at admission. The most common primary tumors were colorectal (21.6%), breast (20.1%), lung (8.6%), and gastric (8.6%). Over half (56%) received platin-based regimens, usually in association with fluoropyrimidines or taxanes. Pain (33%), nausea (23%) and fever (16%) were the most referred symptoms at admission. The main diagnosis at were infection (32%), followed by disease progression (DP) (29%), and chemotherapy associated toxicity (26%). A total of 174 (22%) pts required intensive care unit support during hospital stay. The in-hospital overall mortality rate was 18%. Univariable analysis revealed poor ECOG-PS, grade 3 anemia, grade 3 thrombocytopenia and DP associated with in-hospital mortality. In the final multivariable model, ECOG ≥ 2 (OR 1.99, CI 95% 1.33 - 2.99, p <0.001), DP (OR 4.62, CI 95% 3.07 - 7.00, p <0.001) and grade 3 anemia (OR 2.38, CI 95% 1.45 - 3.87, p<0.001) remained statistically associated with in-hospital mortality. Conclusions: A substantial percentage of unplanned admissions after chemotherapy treatment are due to toxicity. Poor performance status, progression of disease on admission and severe anemia are associated with worse in-hospital prognosis. Grade 3 anemia on admission was the only toxicity associated with in-hospital mortality. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: R.C. Bonadio: Personal, Expert Testimony: AstraZeneca, Ache;Personal, Research Grant: Novartis;Personal, Roche. All other authors have declared no conflicts of interest.
ABSTRACT
Background: Patients older than 80 years with cancer are more likely to be late-diagnosed, and less likely to receive optimal cancer treatment, compared to younger geriatric patients. Understanding the factors that influence these patient's outcomes is essential to guide their management and proper choice of assistance. Methods: A retrospective cohort of patients with solid tumors older than 80 years admitted to a tertiary, publicly-funded, cancer center in Brazil, from February 1st to December 31st, 2021. COVID-19 diagnoses were excluded. We collected data on staging, body mass index (BMI), comorbidities, ECOG-PS, symptoms, admission diagnoses, and in-hospital mortality. The age-adjusted Charlson Comorbidity Index [CCI] was further calculated. We investigated the association between collected variables of interest and in-hospital mortality with uni and multivariable logistic regression models. Results: Of 440 patients, the median age was 84 (IQR 81-87) and 58% were men. Prevalent cancer diagnoses were prostate (22%), breast (12%), colon (9.5%), and lung cancer (8.1%). Before admission, 42% of patients had distant metastasis, while 21% had no evidence of disease. Two-thirds of patients had poorer ECOG-PS (≥2), and the median CCI was 10 (IQR 8-11). Comorbidities included cardiovascular disease (29%), chronic renal disease (13%), dementia (9.5%) and COPD (9.1%). Pain (27%), dyspnea (18%), and altered level of consciousness (16%) were the most prevalent complaints. During hospitalization, 35% had an infection diagnosis and 26% had progression of disease. The overall in-hospital mortality rate was 25%. Higher CCI (OR 1.24, 95%CI 1.11-1.38), poorer ECOG-PS (OR 2.17, 95%CI 1.29-3.77), and progression of disease (OR 2.77, 95%CI 1.62-4.75) were associated with in-hospital mortality after univariable regression and remained all statistically significant in the multivariable model. BMI and age were not associated with poorer outcomes. Conclusions: Hospitalized patients with cancer aged 80 years and older have a high mortality rate. The Charlson Comorbidity Index, a comorbidity burden score that includes cancer staging, correlates with in-hospital mortality and therefore could guide supportive care decisions for older adults. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: R.C. Bonadio: Financial Interests, Personal, Expert Testimony: AstraZeneca, Ache;Financial Interests, Personal, Research Grant: Novartis;Financial Interests, Personal, Sponsor/Funding: Roche. All other authors have declared no conflicts of interest.