Causes of unplanned hospitalizations and factors associated with in-hospital mortality among patients receiving chemotherapy treatment

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.