Acute hospitalizations in cancer patients treated with definitive radiotherapy: A retrospective cohort study with implications for an urgent care clinic.

Abstract

312 Background: Reasons for hospitalizations in patients undergoing curative-intent radiotherapy (RT) have not been well characterized previously. Implementation of urgent cancer care clinics could decrease rates of hospitalization, but the reasons for acute visits must be better understood. This retrospective cohort study investigates emergency department (ED) visits or admissions in patients treated with definitive RT. Methods: Under an IRB-approved protocol, the cohort was defined as all consecutive patients >=18 yo who began RT (RTSTART) between 7/1/11 and 12/31/13 for nonmetastatic disease with curative intent. An acute encounter was defined as an ED visit or inpatient admission during RT or 30 days after the conclusion of RT (30DA). Results: A total of 1852 unique RT courses from 1823 patients were identified, within which there were 666 RT unique courses (657 patients) who had at least one acute encounter. There were 1006 acute encounters, comprising 287 ER and 719 inpatient visits. The number of admissions per RT course ranged from 1 to 9, with <13% with >3. The mean difference between post- and pre-RT ECOG performance status was greater for patients with acute encounters than those without (0.47 vs. 0.06). For those admitted, the median days from RTSTART to admission were 36 (0-81) and 68.2% received concurrent chemotherapy. Conclusions: In this large analysis from a single quaternary cancer center,over one-third of patients receiving curative-intent RT had an acute encounter, a high percentage of whom received chemotherapy. Further investigations are needed to classify which admissions were unanticipated, which in turn would guide design of urgent cancer care centers for RT patients and improve quality of care. [Table: see text]