Urgent versus elective inpatient anticancer therapy in patients with metastatic solid tumors: Analysis of admission characteristics and posthospitalization clinical outcomes.

Abstract

12 Background: Palliative chemotherapy is used urgently in the hospital due to rapid disease progression, risk of toxicity, or other cancer-related acute medical diagnoses. Our primary objective was to characterize the utilization of urgent anticancer therapy (antiCT) in metastatic solid tumor patients. Secondary objectives were to compare time to next treatment (TTNT) and overall survival (OS) between those who received antiCT during urgent and elective admissions, and to further characterize if goals of care (GOC) or prognosis discussions were included in the decision process. Methods: This was a single-center observational cohort study of patients with advanced solid tumors treated with antiCT during urgent versus elective inpatient admissions at Huntsman Cancer Institute from June 1, 2014 to June 30, 2016. Line of therapy, ICU utilization, readmission rate, palliative care (PC) consultation, and documentation of GOC and prognosis discussions were evaluated for patients who received urgent antiCT. Results: 265 patients were included. The majority were treated during urgent admissions (63.7%). Patients receiving urgent antiCT were older (57.6 ± 14.2 vs 54.9 ± 14.9 years, p < 0.001) with more advanced cancer at diagnosis (56.8% vs 37.5%, p = 0.009). Urgent antiCT was associated with both decreased median TTNT (3.5 vs 15.7 months; p < 0.001) and median OS (4.7 vs 31.4 months; p < 0.001) as compared to elective antiCT. Of those who received urgent antiCT, 47.9% were started on a new antiCT during admission. First-line therapy accounted for 58% of urgent antiCT, and 27.2% was third-line or higher. ICU care was utilized for 20.7% of these patients, and 23.1% were readmitted ≤30 days after discharge. PC was consulted for 37.9% during admission. Less than half (41.4%) had a documented GOC discussion; only 32.5% had a documented prognosis discussion. Conclusions: Urgent inpatient antiCT is associated with suboptimal advance care planning despite high risk of mortality in the 5 months following admission. Efforts to identify predictors of early mortality after urgent antiCT and incorporate earlier GOC and prognosis discussions are warranted.