Association of Hospitalist Care and Outcomes on an Inpatient Elective Anticancer Therapy Service

Abstract

Background: Hospitalist care is becoming increasingly common at cancer centers. Here, we assess the impact of oncology hospitalist care on quality outcomes on an inpatient elective anticancer therapy service for patients with leukemia and lymphoma. Methods: On July 26, 2021, the Smilow Cancer Hospital transitioned the elective anticancer therapy team from a hematologic oncologist-led traditional service (TS) to an oncology hospitalist-led service (HS). We compared quality outcomes for patients with leukemia and lymphoma requiring elective anticancer therapy who were admitted during two parallel 18-month periods (TS: July 1, 2018 to December 31, 2019; HS: July 26, 2021 to December 31, 2022). Longitudinal data analysis using mixed linear regression models with random effects for intercept (individual) and slope (time) were used to estimate the association between service and outcome, accounting for patients with multiple admissions reflecting sequential cycles of chemotherapy. The outcomes were length-of-stay (LOS), time from admission to first anticancer therapy administration, and discharge time of day. Models were adjusted for age, sex, race/ethnicity, diagnosis, anticancer therapy type, Severity of Illness index, and total elapsed time since cycle 1/day 1 of the index regimen. Results: The study included 161 patients, 59 from the TS and 102 from the HS. There were 65 patients with leukemia and 96 with lymphoma. No significant differences in median age, sex, race/ethnicity, or severity of illness index between services were observed (p>0.05). The most common anticancer regimen was etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) for lymphoma (TS n=16 (27%); HS n=31 (30%)). For anticancer regimens with a fixed number of treatment days, after adjustment, we observed a significant reduction of length of stay that exceeded one full day (TS=6.09 days (95% CI: 6.09, 6.95 days); HS=3.82 days (95% CI:3.48, 4.16 days); p<0.001), the adjusted mean time from admission to first anticancer therapy administration decreased by 4.12 hours (95% CI: 0.66, 7.59 hours; p<0.001), and the adjusted mean discharge time decreased by 66 minutes (95% CI: 9, 211 minutes; p=0.01) ( Table 1). For those regimens that required variable monitoring for post-treatment methotrexate clearance or tumor lysis syndrome, no significant difference in outcomes was noted (p>0.05). Conclusions: Hospitalist care on an inpatient elective anticancer therapy service was associated with significant improvements in LOS, time from admission to anticancer therapy administration, and discharge time.