Contemporary use of inpatient antineoplastic (IP) treatment (Rx): Who is getting care and why?

Abstract

e18015 Background: The steady trend towards outpatient antineoplastic medication delivery has been spurred by improvements in supportive care, innovations in drug delivery, and financial considerations. Despite these trends, a significant number of patients (pts) continue to receive IP Rx for both hematological (HM) and solid cancers (ST). The purpose of this study is to describe a single center’s experience with IP Rx between 01/01/2015 and 12/31/2017. Methods: All pts ( > 18yo) who received IP Rx for a cancer diagnosis, exclusive of stem cell transplantation, were identified from hospital pharmacy records. Patient and disease characteristics were collected at the index (initial) admission. All pts were followed for 1 year after index admission for 30-day readmission and subsequent admissions for IP Rx. Reasons for IP Rx included: urgent/emergent initiation of Rx; high acuity inpatient management for ST (e.g., intraperitoneal, intra-arterial, intravesical therapy) or complex HM regimen; ongoing Rx; palliation. Results: A total of 266 index admissions were identified with 66.2% of pts having a HM (n = 176) and 33.8% having a ST (n = 90). IP Rx was classified as urgent for 48.1% of pts (n = 128); 70.3% (n = 90) of these admissions were new diagnoses of which 91.4% (n = 86) were HM. High acuity IP management was required for 37.5% of pts (n = 100) (47% for ST (n = 47) and 53% for HM (n = 53)). The remaining index admissions were classified as ongoing Rx for 4.5% of pts (n = 12) and palliation for 9.8% (n = 26). Pts with ST required intensive care significantly more often than pts with HM (57.8% vs. 15.9%, p < 0.001) but with no difference in inpatient mortality (4.4% vs. 5.7%, p = 0.891). The 30-day readmission rate was 32.2% for ST and 25.6% for HM (p = 0.515). After the index admission, 10% of ST pts and 60.2% of HM pts had at least 1 subsequent admission for IP Rx (p < 0.001). Conclusions: In this 3-year retrospective review, the vast majority of pts receiving IP Rx required either urgent initiation of care or high acuity care, currently only available in the inpatient setting. While there is little evidence of routine IP Rx or opportunity, at present, to transition further care to the outpatient setting, the high rates of 30-day readmission warrant further evaluation.