Predictors of Unplanned Hospitalizations in Patients With Nonmetastatic Lung Cancer During Chemotherapy.

PURPOSE/OBJECTIVES: To determine predictors of unplanned hospitalizations in patients with lung cancer to receive chemotherapy in the outpatient setting and examine the potential financial burden of these events.
. DESIGN: Retrospective, longitudinal cohort study.
. SETTING: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.
. SAMPLE: Of 104,388 incident cases of lung cancer diagnosed from 2005-2009, 2,457 cases of patients with lung cancer who received outpatient chemotherapy were identified. Patients were aged 66 years or older at diagnosis, had uninterrupted Medicare Part A and B coverage with no health maintenance organization enrollment, and received IV chemotherapy at least once.
. METHODS: Generalized estimating equations was used.
. MAIN RESEARCH VARIABLES: Patient age, sex, race, marital status, degree of residential urbanization, median income, education level, stage, receipt of radiation therapy, and comorbidities.
. FINDINGS: Younger age, non-White race, lower education, higher income, receipt of radiation therapy, and lack of preexisting comorbidity were significant predictors of the likelihood of an initial unplanned hospitalization for lung cancer. Non-White race, receipt of radiation therapy, and comorbidity were factors associated with an increased number of hospitalizations. 
. CONCLUSIONS: Unplanned hospitalizations are frequent, disruptive, and costly. This article defines areas for further exploration to identify patients at high risk for unexpected complications. 
. IMPLICATIONS FOR NURSING: This article represents a foundation for development of risk models to enable nursing evaluation of patient risk for chemotherapy treatment interruption and unplanned hospitalization.

Factors Associated With Unplanned Hospitalizations Among Patients With Nonmetastatic Colorectal Cancers Intended for Treatment in the Ambulatory Setting.

BACKGROUND: Chemotherapy administration and supportive management for solid tumors is intended to take place in the ambulatory setting, but little is known about why some patients experience treatment-related adverse events so severe as to require acute inpatient care. OBJECTIVE: The aim of the study was to identify predictors of initial and repeated unplanned hospitalizations and potential financial impact among Medicare patients with early-stage (Stages I-III) colorectal cancer receiving outpatient chemotherapy. METHODS: Advanced statistical modeling was used to analyze a cohort of patients (N = 1,485) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed from 2003 to 2007 with colorectal cancer as their first primary malignancy. Patients were of ages 66 and older at diagnosis, had uninterrupted Medicare Parts A and B coverage with no health maintenance organization component, and received chemotherapy at least one time. RESULTS: Female gender, younger age, multiple comorbidities, rural geography, higher high school completion rates, and lower median income per census tract were significant predictors of the likelihood of initial unplanned hospitalizations. Non-White race, receipt of radiation therapy, rural geography, and higher weighted comorbidity scores were factors associated with the number of hospitalizations experienced. The total Medicare charges calculated for these admissions was $38,976,171, with the median charge per admission at $20,412. DISCUSSION: Demographic and clinical factors that form the foundation of work toward development of a risk factor profile for unplanned hospitalization were identified. Further work is needed to incorporate additional clinical data to create a clinically applicable model.