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Factors Associated With Unplanned Hospitalizations Among Older Patients Receiving Chemotherapy


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In a study reported in JCO Oncology Practice, Klepin et al identified several factors associated with unplanned hospitalizations and hospital length of stay among patients with cancer aged 65 and older receiving chemotherapy.

Study Details

The study was a secondary analysis in a U.S. multisite prospective cohort study that attempted to develop and validate a predictive model for severe chemotherapy toxicity in older adults evaluated with a geriatric assessment tool. In the current analysis, the primary outcome measure was unplanned hospitalizations during chemotherapy treatment; the secondary outcome measure was length of stay for the first hospitalization. Independent variables included in analyses consisted of pretreatment geriatric assessment measures, laboratory values, cancer type and stage, and treatment intensity characteristics.

Readily available geriatric assessment variables and laboratory data, but not age, were associated with unplanned hospitalizations among older adults receiving chemotherapy. If validated, these data can inform prediction models and the design of interventions to decrease unplanned hospitalizations.
— Klepin et al

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Key Findings

Among 750 patients included in the analysis, the median age was 72 years (range = 65–94); 59% had stage IV disease; 70% were receiving first-line chemotherapy; and the most common types of cancer were lung (27.6%), gastrointestinal (27.1%), breast (15.5%), and gynecologic (14.0%).

At least one unplanned hospitalization occurred in 193 patients (25.7%) during chemotherapy. A total of 162 patients (82.9%) were hospitalized once, and 31 (16.1%) were hospitalized at least twice. The most common reasons for hospitalization were infection (51%) and gastrointestinal symptoms (14.5%).

Among 181 patients with available data, median length of stay for the first hospitalization was 4 days (range = 1–66 days). In multivariate analysis, factors associated with increased length of stay were older age, self-reported presence of liver or kidney disease, living alone, and depressive symptoms (Hospital Anxiety Depression Scale [HADS] depression subscale score ≥ 6). After adjustment for age, the least square mean duration of hospitalization was 11.6 vs 5.9 days (P = .01) for patients with vs without liver or kidney disease, 8.6 vs 5.5 days (P = .03) for patients living alone vs with someone, and 9.5 vs 5.1 days (P = .001) for patients with vs without HADS depression subscale score ≥ 6.

The investigators concluded, “Readily available geriatric assessment variables and laboratory data, but not age, were associated with unplanned hospitalizations among older adults receiving chemotherapy. If validated, these data can inform prediction models and the design of interventions to decrease unplanned hospitalizations.”

Heidi D. Klepin, MD, MS, of Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by the National Institute on Aging, ASCO and Association of Specialty Professors through the Junior Development Award in Geriatric Oncology, City of Hope’s Center for Cancer and Aging, and others. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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