Characteristics of Inpatient Radiation Therapy Use

Abstract

Purpose/Objective(s)Radiation therapy (RT) patients receive the majority of their care in the outpatient setting. Relatively little is known regarding inpatient use of RT. The primary objective of this study was to characterize demographics and types of malignancies for inpatients receiving RT. Secondary goals were to determine lengths of stay (LOS) attributable to these patients.Materials/MethodsThe cohort was derived from the 2012 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a representative dataset of admissions in the United States. Patients receiving RT were selected from the dataset for further analysis using descriptive statistics and univariate and multivariate regression.ResultsOf 7,296,968 admissions in the NIS dataset, 14,086 (0.193%) involved an RT procedure. Most procedures were coded as “other radiotherapeutic procedure” (N=10,257), “tele-radiation therapy using photons” (N=1 828), or “implantation/insertion of radioactive elements” (N=792). 3.4% of admissions had multiple procedures, and of these, the median number of procedures was 3 (interquartile range 2-5 procedures). The median LOS for all RT-associated admissions was 6 days; overall, 13 292 (94.4%) of the RT-associated admissions were associated with a cancer diagnosis; 5 868 of these admissions (44.2%) were not associated with metastatic disease. The most common sites in non-metastatic admissions were head and neck (N=1 398), lung (N=1 128 admissions), and GI (N=918); 7 424 cancer-related admissions (55.9%) were associated with metastases, the most common of which included bone (N=3 912), CNS (N=2 889), liver (N=1 710), and lung (N=1 500). Of these, 3 576 (48.2%) had multiple metastatic sites. Do not resuscitate (DNR) status was recorded for 1 498 (10.63%) of all RT admissions. Among the metastatic RT patient admissions, 1 096 admissions (14.8%) had DNR status, 1 051 (14.2%) involved palliative care consultation, and 548 had both; 385 (5.2%) RT patients with metastatic disease died during their stay. Univariate linear regressions were used to identify significant relationships between LOS and age, sex, number of diagnoses, insurance, operating room procedure, metastases, DNR status, palliative care, number of procedures, number of RT procedures, type of RT procedure, and race. In a multivariable linear regression, DNR status and palliative care consultations correlated with longer LOS. Average LOS for patients with DNR was 12.1 days versus 9.2 without (P=.011), and 13.3 days when palliative care was consulted versus 9.1 days when not (P=.001).ConclusionApproximately half of inpatient admissions receiving RT are associated with metastatic cancer. Among those patients, palliative care or DNR status occurred approximately 15% of the time, and these factors correlated with slightly longer lengths of stay Purpose/Objective(s)Radiation therapy (RT) patients receive the majority of their care in the outpatient setting. Relatively little is known regarding inpatient use of RT. The primary objective of this study was to characterize demographics and types of malignancies for inpatients receiving RT. Secondary goals were to determine lengths of stay (LOS) attributable to these patients. Radiation therapy (RT) patients receive the majority of their care in the outpatient setting. Relatively little is known regarding inpatient use of RT. The primary objective of this study was to characterize demographics and types of malignancies for inpatients receiving RT. Secondary goals were to determine lengths of stay (LOS) attributable to these patients. Materials/MethodsThe cohort was derived from the 2012 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a representative dataset of admissions in the United States. Patients receiving RT were selected from the dataset for further analysis using descriptive statistics and univariate and multivariate regression. The cohort was derived from the 2012 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), a representative dataset of admissions in the United States. Patients receiving RT were selected from the dataset for further analysis using descriptive statistics and univariate and multivariate regression. ResultsOf 7,296,968 admissions in the NIS dataset, 14,086 (0.193%) involved an RT procedure. Most procedures were coded as “other radiotherapeutic procedure” (N=10,257), “tele-radiation therapy using photons” (N=1 828), or “implantation/insertion of radioactive elements” (N=792). 3.4% of admissions had multiple procedures, and of these, the median number of procedures was 3 (interquartile range 2-5 procedures). The median LOS for all RT-associated admissions was 6 days; overall, 13 292 (94.4%) of the RT-associated admissions were associated with a cancer diagnosis; 5 868 of these admissions (44.2%) were not associated with metastatic disease. The most common sites in non-metastatic admissions were head and neck (N=1 398), lung (N=1 128 admissions), and GI (N=918); 7 424 cancer-related admissions (55.9%) were associated with metastases, the most common of which included bone (N=3 912), CNS (N=2 889), liver (N=1 710), and lung (N=1 500). Of these, 3 576 (48.2%) had multiple metastatic sites. Do not resuscitate (DNR) status was recorded for 1 498 (10.63%) of all RT admissions. Among the metastatic RT patient admissions, 1 096 admissions (14.8%) had DNR status, 1 051 (14.2%) involved palliative care consultation, and 548 had both; 385 (5.2%) RT patients with metastatic disease died during their stay. Univariate linear regressions were used to identify significant relationships between LOS and age, sex, number of diagnoses, insurance, operating room procedure, metastases, DNR status, palliative care, number of procedures, number of RT procedures, type of RT procedure, and race. In a multivariable linear regression, DNR status and palliative care consultations correlated with longer LOS. Average LOS for patients with DNR was 12.1 days versus 9.2 without (P=.011), and 13.3 days when palliative care was consulted versus 9.1 days when not (P=.001). Of 7,296,968 admissions in the NIS dataset, 14,086 (0.193%) involved an RT procedure. Most procedures were coded as “other radiotherapeutic procedure” (N=10,257), “tele-radiation therapy using photons” (N=1 828), or “implantation/insertion of radioactive elements” (N=792). 3.4% of admissions had multiple procedures, and of these, the median number of procedures was 3 (interquartile range 2-5 procedures). The median LOS for all RT-associated admissions was 6 days; overall, 13 292 (94.4%) of the RT-associated admissions were associated with a cancer diagnosis; 5 868 of these admissions (44.2%) were not associated with metastatic disease. The most common sites in non-metastatic admissions were head and neck (N=1 398), lung (N=1 128 admissions), and GI (N=918); 7 424 cancer-related admissions (55.9%) were associated with metastases, the most common of which included bone (N=3 912), CNS (N=2 889), liver (N=1 710), and lung (N=1 500). Of these, 3 576 (48.2%) had multiple metastatic sites. Do not resuscitate (DNR) status was recorded for 1 498 (10.63%) of all RT admissions. Among the metastatic RT patient admissions, 1 096 admissions (14.8%) had DNR status, 1 051 (14.2%) involved palliative care consultation, and 548 had both; 385 (5.2%) RT patients with metastatic disease died during their stay. Univariate linear regressions were used to identify significant relationships between LOS and age, sex, number of diagnoses, insurance, operating room procedure, metastases, DNR status, palliative care, number of procedures, number of RT procedures, type of RT procedure, and race. In a multivariable linear regression, DNR status and palliative care consultations correlated with longer LOS. Average LOS for patients with DNR was 12.1 days versus 9.2 without (P=.011), and 13.3 days when palliative care was consulted versus 9.1 days when not (P=.001). ConclusionApproximately half of inpatient admissions receiving RT are associated with metastatic cancer. Among those patients, palliative care or DNR status occurred approximately 15% of the time, and these factors correlated with slightly longer lengths of stay Approximately half of inpatient admissions receiving RT are associated with metastatic cancer. Among those patients, palliative care or DNR status occurred approximately 15% of the time, and these factors correlated with slightly longer lengths of stay