Unforeseen Hospital Admissions Are Frequent for Patients Receiving Radiotherapy

July 2012, Vol 3, No 5

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 an analysis by Nabeel H. Arastu, BS, and colleagues at the Brody School of Medicine at East Carolina University, Greenville, NC, which was presented at the 2012 ASCO meeting.

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.

As part of the analysis, data were collected from the electronic health records of 500 patients with cancer. The patients had received external beam radiotherapy in 2010 at a facility at the University of North Carolina School of Medicine in Chapel Hill. Relevant clinical information and unexpected hospital stays that took place within 90 days of radiotherapy treatment startup were documented.

The objective was to find out whether there are any clinical markers pre-radiotherapy to understand if some patients are more likely than others to be admitted to the hospital unexpectedly.

A 20% Unexpected Admissions Rate

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%).

Other clinical factors that may influence future unplanned hospital visits include use of pain medicine to control symptoms, weight loss issues, and receipt of intravenous fluid.

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. A multivariate examination indicated that unexpected hospital stays were tied to chemotherapy, treatment goals, and marital status. There 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. According to the researchers, the reason may be that patients undergoing multiple rounds of chemotherapy or treatment for secondary metastases are typically sicker and have more comorbidities than other patients.

Preventive Measures

Mr Arastu and colleagues note that it is important to consider preventive approaches in higher-risk patients so that admission rates can be lowered. They add that unexpected hospital visits may serve as a marker for quality of care in cancer therapy.

To develop measures to trim admission rates and the costs associated with them, the team suggests that it is necessary to understand the frequency of such visits, as well as reliable predictors of why the visits occur in the first place.

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