Independent Predictors for Hospitalization-Associated Radiation therapy Interruptions

Adam Hubler, MD; Daniel V. Wakefield, MD, MPH; Lydia Makepeace, MD; Matt Carnell, BS; Ankur M. Sharma, MD; Bo Jiang, MPH; Austin P. Dove, MD; Wesley B. Garner, MD, MPH; Drucilla Edmonston, MD; John G. Little, BS; Esra Ozdenerol, PhD; Ryan B. Hanson, MS; Michelle Y. Martin, PhD; Arash Shaban-Nejad, PhD; Maria Pisu, PhD; David L. Schwartz, MD

Advances in Radiation Oncology (Nov 2022)

Independent Predictors for Hospitalization-Associated Radiation therapy Interruptions

Adam Hubler, MD,
Daniel V. Wakefield, MD, MPH,
Lydia Makepeace, MD,
Matt Carnell, BS,
Ankur M. Sharma, MD,
Bo Jiang, MPH,
Austin P. Dove, MD,
Wesley B. Garner, MD, MPH,
Drucilla Edmonston, MD,
John G. Little, BS,
Esra Ozdenerol, PhD,
Ryan B. Hanson, MS,
Michelle Y. Martin, PhD,
Arash Shaban-Nejad, PhD,
Maria Pisu, PhD,
David L. Schwartz, MD

Affiliations

Adam Hubler, MD: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
Daniel V. Wakefield, MD, MPH: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; Tennessee Oncology, Nashville, Tennessee
Lydia Makepeace, MD: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
Matt Carnell, BS: University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
Ankur M. Sharma, MD: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
Bo Jiang, MPH: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
Austin P. Dove, MD: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennesse
Wesley B. Garner, MD, MPH: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
Drucilla Edmonston, MD: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
John G. Little, BS: University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
Esra Ozdenerol, PhD: Department of Earth Sciences, University of Memphis, Memphis, Tennessee
Ryan B. Hanson, MS: Department of Earth Sciences, University of Memphis, Memphis, Tennessee
Michelle Y. Martin, PhD: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
Arash Shaban-Nejad, PhD: UTHSC-ORNL Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, Tennesse
Maria Pisu, PhD: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
David L. Schwartz, MD: Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Corresponding author: David L. Schwartz, MD, FACR

Journal volume & issue: Vol. 7, no. 6
p. 101041

Abstract

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Purpose: Radiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and Materials: This retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. Results: Between January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P 20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. Conclusions: HARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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