Chicago, IL—Approximately 1 in 5 patients with cancer who are undergoing radiotherapy as part of their treatment can count on unexpected hospital stays—adding an economic and clinical burden on the patient and on the healthcare system, according to a study by Nabeel H. Arastu, BS, and colleagues at the Brody School of Medicine at East Carolina University, Greenville, NC, which was presented at ASCO 2012.
Unanticipated admissions were common among nearly 33% of patients who received radiotherapy to treat symptoms and were also likely in more than 25% of those receiving simultaneous chemoradiation.
Data were collected from the electronic health records of 500 patients with cancer. The patients had received external beam radiotherapy in 2010.
20% Unexpected Admissions
Of the 500 patients, 101 (20%) had unexpected hospital stays, lasting a mean of 4 days (range, 1-16 days). The mean length of time between a patient beginning radiotherapy and going to the hospital unexpectedly was 32 days (range, 0-86 days).
Reasons for hospital admission included:
- Pain (19% of cases)
- Respiratory issues (15%)
- Neurologic conditions (13%)
- Malaise (7%)
- Fever (5%).
In addition, 33% of patients who were treated palliatively ended up being admitted to the hospital compared with 16% of curative-focused patients.
According to a univariate analysis, 26% of patients who had simultaneous radiotherapy and chemotherapy had unplanned hospital admissions compared with 17% of those receiving only radiotherapy. Unexpected hospital stays were tied to chemotherapy, treatment goals, and marital status.
here were highly inconsistent rates of unexpected hospital visits based on diagnosis—including 37% for metastases; 19% for gastrointestinal, genitourinary, gynecologic, ear, nose, and throat cancers; and 4% for breast cancer.
Patients who were treated with a second or third round of radiotherapy could expect higher admission rates (average, 27%) compared with those who received only 1 treatment round (16%). Furthermore, patients who were undergoing treatment for secondary metastases typically experienced a much higher rate of unexpected hospital visits, possibly because patients undergoing multiple rounds of chemotherapy for secondary metastases are typically sicker and have more comorbidities.—CH