Is inpatient chemotherapy overutilized?

Abstract

215 Background: Inpatient palliative chemotherapy has been associated with more aggressive end of life care, reduced utilization of hospice services and decreased quality of life. The decision to administer chemotherapy in the inpatient setting is not always standardized which may lead to overutilization. Methods: We performed a retrospective chart review of all patients who received inpatient chemotherapy at an Academic center during the year 2016. Patients were stratified by solid tumor (ST) versus hematologic malignancies (HM) and assessed for the urgency of chemotherapy. We also evaluated response to treatment, death within 30 days of chemotherapy administration, and other qualitative and quantitative variables. We used descriptive statistics and odds ratios (OR) were estimated from logistic regression models. Results: We identified 141 patients; 47% HM. Select significant patient outcomes (p-value ≤0.05) are summarized in Table. At the time of admission, the majority of ST patients had stage 4 cancer (71%) with a poorer performance status (p= 0.0005) and were more often admitted due to symptoms related to their cancer (p<0.0001). HM patients were more likely to be directly admitted for chemotherapy (p<0.0001). Among ST patients, 29% received chemotherapy because the admission coincided with a non-urgent planned cycle compared to 11% of HM. Reason for inpatient chemotherapy was documented as urgent for 94% HM and 67% ST patients. ST patients were more likely to receive a palliative care consult (65% vs 24%; p<0.001) and to die within 30 days of index admission (15.8% vs 6.2%; p=0.019). In the adjusted analysis, the most important factor associated with urgent chemotherapy was the cancer type (OR: 8.25, 95% CI 2.13-31.97, p=0.002). Conclusions: Our study indicates that there is an overutilization of inpatient chemotherapy in ST patients as well as increased mortality within 30 days of inpatient chemotherapy administration compared to HM. The administration of inpatient chemotherapy can be avoided in many cases which can lead to improved quality of life and cost savings. Creation of a standardized algorithm on the appropriateness of inpatient chemotherapy may be a useful tool to guide decision making. [Table: see text]