JCO Global Oncology (Jul 2024)

Unplanned Hospital Admissions in Patients With Solid Tumors in Brazil: Causes and Progressive Disease's Impact on Outcomes

  • Cassio Murilo Hidalgo Filho,
  • Felippe Lazar Neto,
  • Vitor Pinheiro Sobottka,
  • João Wilson da Rocha,
  • Lucas Tadeu Barrak Stangler,
  • Heloisa Guedes Andrade,
  • Gustavo Benfatti Olivato,
  • Mateus Zapparoli Claro,
  • Danillo Zeferino de Oliveira Souza,
  • Victor Junji Yamamoto,
  • Mateus Marinho Nogueira Soares,
  • Maria del Pilar Estevez-Diz,
  • Paulo M. Hoff,
  • Renata Colombo Bonadio

DOI
https://doi.org/10.1200/GO.24.00063
Journal volume & issue
no. 10

Abstract

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PURPOSEMost patients with cancer will be hospitalized throughout the disease course. However, most evidence on the causes and outcomes of these hospitalizations comes from administrative data or small retrospective studies from high-income countries.METHODSThis study is a retrospective cohort of patients with solid tumors hospitalized from February 1, 2021, to December 31, 2021, in a tertiary cancer center in São Paulo, Brazil. We collected data on cancer diagnosis, symptoms at admission, hospitalization diagnosis, and survival clinical outcomes during in-hospital stay (in-hospital mortality) and after discharge (readmission rates and overall survival [OS]). Progressive disease (PD) diagnosis during admission was retrieved from manual chart review if explicitly stated by the attending physician. We modeled in-hospital mortality and postdischarge OS with logistic regression and Cox proportional hazards models, respectively.RESULTSA total of 3,726 unique unplanned admissions were identified. The most common symptoms at admission were pain (40.6%), nausea (16.8%), and dyspnea (16.1%). PD (34.0%), infection (31.1%), and cancer pain (13.4%) were the most frequent reasons for admission. The in-hospital mortality rate was 18.9%. Patients with PD had a high in-hospital mortality rate across all tumor groups and higher odds of in-hospital death (odds ratio, 3.5 [95% CI, 3.0 to 4.2]). The 7-, 30-, and 90-day readmission rates were 11.9%, 33.5%, and 54%, respectively. The postdischarge median OS (mOS) was 12.6 months (95% CI, 11.6 to 13.7). Poorer postdischarge survival was observed among patients with PD (mOS, 5 months v 18 months; P < .001; hazard ratio, 2.4 [95% CI, 2.1 to 2.6]).CONCLUSIONPD is a common diagnosis during unplanned hospitalizations and is associated with higher in-hospital mortality rates and poorer OS after discharge. Oncologists should be aware of the prognostic implications of PD during admission and align goals of care with their patients.