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Clinical data indicate patient-specific risks for chemotherapy-related hospitalization
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Individual patient clinical data available in electronic health records may predict the risk for palliative chemotherapy-related hospitalization, according to study results.
“In patients with advanced cancer, hospitalization is a common and costly adverse event,” Gabriel A. Brooks, MD, of the Dana-Farber Cancer Institute, and colleagues wrote. “While most hospitalizations in this patient population are precipitated by cancer-related symptoms, approximately 30% are triggered by adverse effects of chemotherapy.”
Determining which patients face a high risk for chemotherapy-related hospitalization may help direct prevention strategies, according to study background.
Brooks and colleagues enrolled 1,579 patients with advanced solid-tumor cancers who initiated palliative chemotherapy. Of the initial cohort, 9% (n = 146) experienced a chemotherapy-related hospitalization and were selected for the case cohort. Median time to hospitalization after chemotherapy initiation was 30 days, and 73% of these patients were hospitalized within 60 days of initiation.
Researchers randomly selected a control arm composed of 292 patients from the remaining patients in the initial cohort who were not hospitalized.
Median age was similar in both study arms (68 years vs. 67 years), and both groups were 54% female. The most commonly diagnosed cancers in both cohorts were breast, lung and gastrointestinal tract cancers.
Researchers analyzed presumed risk factors for treatment-related hospitalization in each individual patient based on data from their medical records.
Results of a multivariable analysis suggested seven factors were significantly associated with chemotherapy-related hospitalization. These variables included younger age (each 1-year increase, OR = 0.96; 95% CI, 0.94-0.98), higher Charlson comorbidity score (score of 1, OR = 2.79; 95% CI, 1.63-4.75; score ≥ 2, OR = 3.67; 95% CI, 2.23-6.03), lower creatinine clearance (per each 10 mL/min increase, OR = 0.87; 95% CI, 0.82-0.93), lower calcium levels (per each 1 mg/dL increase, OR = 0.47; 95% CI, 0.33-0.67), lower than normal white blood cell and/or platelet count (OR = 5.02; 95% CI, 2.25-11.24), treatment with multiple chemotherapy agents (OR = 1.8; 95% CI, 1.21-2.66) and treatment with camptothecin chemotherapy (OR = 2.02; 95% CI, 1.14-3.57).
Using these variables, the median predictive risk for chemotherapy-related hospitalization was 14.7% (interquartile range [IQR], 6.8-22.5) in the case cohort and 6% (IQR, 3.6-11.4) in the control group. The bootstrap-adjusted C statistic was 0.71 (95% CI, 0.66-0.75).
Using a 15% chemotherapy-related hospitalization risk threshold, researchers calculated the model to have a sensitivity of 49% (95% CI, 41-57) and a specificity of 85% (95% CI, 81-89).
The researchers acknowledged the use of a qualitative consensus review to differentiate hospitalizations related to chemotherapy from hospitalization caused by other factors may be a limitation to these findings. The model also did not account for specific geriatric risk factors and excluded patients who underwent longer treatment and may have eventually experienced hospitalization, according to the researchers.
“Because our model used data that are available from within structured fields in electronic health records, our approach could be used to create an automated clinical decision support tool at the point of chemotherapy order entry, without requiring additional data entry,” Brooks and colleagues concluded. “In this context, an externally validated prediction model could be used by physicians to counsel patients about their individual level risk of chemotherapy-related hospitalization during shared decision making around initiation of chemotherapy.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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