Is hospitalization within 6 months of completion of radiation therapy for endometrial cancer associated with decreased survival? (584)

Abstract

<b>Objectives:</b> Radiation therapy (RT) is a core component in the management of women with locally advanced endometrial cancer (EC). For patients with early-stage (I and II), intermediate-risk disease, adjuvant RT is considered the standard of care. We hypothesized that hospitalization within six months of the completion of RT was associated with decreased overall survival (OS) and progression-free survival (PFS). We tried to identify factors predictive of a patients' likelihood of hospitalization within a short term of RT completion. <b>Methods:</b> An IRB-approved, retrospective cohort study included all patients who were diagnosed with EC and treated with radiation at our institution from January 2019 through December 2020. Data collected included functional status, disease stage, treatment course, hospitalizations, and demographics. Performance status was monitored via the Kamofsky Performance Scale. Common terminology criteria for adverse event (CTCAE) constipation and fatigue grades were gathered to provide insight into a patient's tolerance of RT. Statistical analysis was performed via Fisher's exact test. The Kaplan-Meier product estimator was utilized to derive survival curves, which were then compared via log-rank test. A critical value of p <0.05 was set for statistical significance. <b>Results:</b> Of 287 eligible patients, 27 (9.4%) were hospitalized within six months of RT. Of those patients, 13 of 27 (48%) were hospitalized within 30 days of completion of RT, and an additional five patients were hospitalized within 45 days of completion of radiation. The median length of hospitalization was six days, with hospital stays ranging from one to 20 days. Of patients who were hospitalized, 15 received EBRT alone, ten received vaginal brachytherapy alone, and two received a combination of EBRT + brachytherapy. The most common indications for hospitalization included disease progression, vaginal bleeding, altered mental status, failure to thrive, infection, and cardiovascular events. Most patients (21/27) did not undergo procedural intervention during their hospitalization, although two patients were admitted to the intensive care unit, and ultimately five of 27 patients expired during the hospitalization. Of the patients who expired, 40% of deaths were disease-related, while 60% were from other causes. Of the six patients who underwent procedural intervention during their admission, interventions included palliative RT, uterine artery embolization, biopsy, pleural catheter placement, and scheduled procedures unrelated to their disease process, inclusive of cholecystectomy and colonoscopy. Hospitalization within six months was associated with both decreased OS (p < 0.0001) and decreased PFS (p <0.0001). There was no significant variation in performance status, as indicated by Kamofsky's performance score, between patients who were and were not hospitalized within six months of completion of RT. BMI, age, constipation, and fatigue were not statistically significant predictors of a patients' likelihood of short interval hospitalization. <b>Conclusions:</b> Women with EC who received RT as part of their treatment and were hospitalized within six months had a statistically significant decreased OS and PFS. Age, BMI, race, and performance status were not found to be predictive of a patient's risk of short interval hospitalization.