Hospitalized Lung Cancer Patients Research Articles

EP.15B.05 Predictors of 30-Day Mortality after Systemic Therapy in Hospitalized Lung Cancer Patients: A Retrospective Single-Center Observational Study

EP.15B.05 Predictors of 30-Day Mortality after Systemic Therapy in Hospitalized Lung Cancer Patients: A Retrospective Single-Center Observational Study

Disparities in the prevalence of febrile neutropenia in patients hospitalized with lung cancer: An observational study.

e24133 Background: Lung cancer is a leading cause of cancer-related deaths in the United States and globally.Febrile neutropenia is a well-known and often fatal condition that occurs in 10-40% of lung cancer patients undergoing chemotherapy but has not been widely studied so far in these patients. We conducted a retrospective analysis to understand better the prevalence and disparities of febrile neutropenia in patients with lung cancer. Methods: The National Inpatient Sample (NIS) for the years 2017-2020 was utilized to identify patients with a primary discharge diagnosis of lung cancer which included both regional and metastatic disease. The cohort was stratified based on the presence or absence of Febrile Neutropenia (FN). Basic demographic variables were analyzed in order to identify disparities in the prevalence of FN among patients with lung cancer. Multivariate regression analysis was employed to determine the association between FN and lung cancer. Results: Among 461,975 hospitalized lung cancer patients, 4,355(0.09%) had concurrent diagnoses of febrile neutropenia (FN). Patients who developed FN were younger than those who did not (65.42±11.69 vs 68.81±10.39, p < 0.001). Older patients had a decreased likelihood of developing FN (36-45: OR = 0.36(0.16-0.79), p = 0.011; 46-64:OR = 0.26(0.13-0.51), p < 0.001 ; > 65: OR = 0.19(0.09-0.38), p < 0.001 ). The FN group had a greater proportion of black (17.81% vs 12.81%) and Hispanic (7.37% vs 5.25%, p < 0.001) populations, and these groups were more likely to develop FN than white patients (Black: OR = 1.39(1.14-1.69), p = 0.001; Hispanics: OR = 1.4(1.03-1.88), p = 0.027 ). Patients with a Charlson Comorbidity Index of 3 or higher had an increased likelihood of FN (OR = 1.39(1.09-1.76); p = 0.006). The FN group had a higher percentage of patients with Medicaid (15.46% vs. 9.81%) and private insurance (25.21% vs. 22.1%) and a lower percentage of patients with Medicare (56.96% vs. 65.9%), p < 0.001. A greater percentage of patients with FN were discharged to home with home health services (37.35% vs. 31.92%), while a greater percentage of patients without FN were discharged to home (65.31% vs. 59.91%) and skilled nursing facilities (2.06% vs. 1.98%), p = 0.032. Patients in medium and large hospitals were less likely to have FN compared to smaller hospitals (OR = 0.64(0.5-0.82), p = 0.001 and OR = 0.69(0.55-0.86), p = 0.001, respectively). Patients with fluid and electrolyte disorders were more likely to have FN (OR = 1.61(1.37-1.88), p < 0.001). Conclusions: Lung cancer patients who developed Febrile Neutropenia were younger and more likely to be Black and Hispanics. Patients hospitalized in the medium and large size hospitals were less likely to have Febrile Neutropenia in comparison to smaller hospitals. The statistics provide valuable insights for optimizing care and addressing disparities across different age and racial groups.

Front-line liquid biopsy for early molecular assessment and treatment of hospitalized lung cancer patients

BackgroundMolecular characterization is pivotal for managing non-small cell lung cancer (NSCLC), although this process is often time-consuming and patients’ conditions might worsen while molecular analyses are processed.Our primary aim was to evaluate the performance of “up-front” next-generation sequencing (NGS) through liquid biopsy (LB) of hospitalized patients with newly detected lung neoplasm in parallel with conventional diagnosis. The secondary aim included longitudinal monitoring through LB of patients with oncogenic alterations at baseline. MethodsWe enrolled 47 consecutive patients immediately after hospitalization and radiological detection of symptomatic lung neoplasm. LB from peripheral blood was performed at baseline, in parallel with conventional biopsy (CB), when feasible. Additionally, LBs were repeated during treatment in patients with actionable gene alterations at baseline. Oncomine™ Lung cfTNA Research Assay panel was employed for processing plasma samples in NGS. Results47 hospitalized patients were enrolled. LB identified 28 patients with gene alterations, including mutations of EGFR (n = 7), KRAS (n = 12), ERBB2 (n = 1), TP53 (n = 2), BRAF (n = 1), one ALK rearrangement, and 4 patients with combined mutations involving EGFR, KRAS and PIK3CA.LB and CB were consistent, except for two patients. Three patients with positive LB for oncogenic drivers did not undergo CB due to contraindications.Median time to molecular results after LB was significantly lower compared to time to molecular report after CB (11 versus 22 days, p < 0.001). ConclusionsDespite limited numbers, our study supports the role of front-line LB for improving management of symptomatic patients with lung cancer, potentially leading to early targeted therapy initiation.

Prognostic Factors and Outcomes in Advanced Stage Lung Cancer Patients with COVID-19 Omicron Variant Infection.

We study the characteristics and outcomes in lung cancer patients with COVID-19 Omicron variant infection. Hospitalized lung cancer patients with advanced-stage disease and laboratory-confirmed COVID-19 Omicron infection were included. Pneumonitis involving at least 25% of lung parenchyma on CT scans, accompanied by symptoms and oxygen saturation below 93%, were criteria for enrollment. Pneumonitis severity was graded using CTCAE v5.0. Treatment included Paxlovid, prednisolone, anticoagulation, and ventilation. Initial data, radiographic findings, and outcomes were compared. Logistic regression was employed to determine risk factors for in-hospital mortality. Fifteen patients (median age: 65 years; 80.0% males) were included. 73.3% improved and were discharged, 20.0% died, and 6.7% remained intubated. Initial symptoms included cough (100.0%), fever (73.3%), and shortness of breath (53.3%). Symptoms resolved in discharged patients. Median fever duration was 3.5 days, and respiratory symptom recovery took 26 days. Three patients died due to respiratory failure from Omicron pneumonia. Lower oxygen saturation, reduced lymphocyte/neutrophil ratio on day 7, and diffuse bilateral lung lesions were poor prognostic factors. This study underscores the importance of prompt intervention and early diagnosis for lung cancer patients infected with the COVID-19 Omicron variant. Lower oxygen saturation, decreased lymphocyte/neutrophil ratio on day 7, and diffuse lung lesions on CT scans were associated with worse outcomes. Clinicians should prioritize timely and comprehensive management to improve survival rates in this population.

Comparison of seven comorbidity scores on four-month survival of lung cancer patients

BackgroundThe comorbidity burden has a negative impact on lung-cancer survival. Several comorbidity scores have been described and are currently used. The current challenge is to select the comorbidity score that best reflects their impact on survival. Here, we compared seven usable comorbidity scores (Charlson Comorbidity Index, Age adjusted Charlson Comorbidity Index, Charlson Comorbidity Index adapted to lung cancer, National Cancer Institute combined index, National Cancer Institute combined index adapted to lung cancer, Elixhauser score, and Elixhauser adapted to lung cancer) with coded administrative data according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems to select the best prognostic index for predicting four-month survival.Materials and methodsThis cohort included every patient with a diagnosis of lung cancer hospitalized for the first time in the thoracic oncology unit of our institution between 2011 and 2015. The seven scores were calculated and used in a Cox regression method to model their association with four-month survival. Then, parameters to compare the relative goodness-of-fit among different models (Akaike Information Criteria, Bayesian Information Criteria), and discrimination parameters (the C-statistic and Harrell’s c-statistic) were calculated. A sensitivity analysis of these parameters was finally performed using a bootstrap method based on 1,000 samples.ResultsIn total, 633 patients were included. Male sex, histological type, metastatic status, CCI, CCI-lung, Elixhauser score, and Elixhauser-lung were associated with poorer four-month survival. The Elixhauser score had the lowest AIC and BIC and the highest c-statistic and Harrell’s c-statistic. These results were confirmed in the sensitivity analysis, in which these discrimination parameters for the Elixhauser score were significantly different from the other scores.ConclusionsBased on this cohort, the Elixhauser score is the best prognostic comorbidity score for predicting four-month survival for hospitalized lung cancer patients.

Insomnia Burden among Informal Caregivers of Hospitalized Lung Cancer Patients and Its Influencing Factors

ObjectiveThis study aimed to reveal the insomnia burden and relevant influencing factors among informal caregivers (ICs) of hospitalized patients with lung cancer. MethodsA cross-sectional study on ICs of hospitalized patients with lung cancer was conducted from December 31, 2020 to December 31, 2021. ICs’ burden was assessed using the Caregiver Reaction Assessment (CRA), Hospital Anxiety and Depression Scale (HADS), and Insomnia Severity Index (ISI). Linear and logistic regression models were used to identify the influencing factors. ResultsAmong 289 ICs of hospitalized patients with lung cancer, 83 (28.72%), 53 (18.34%), and 14 (4.84%) ICs experienced mild, moderate, and severe insomnia, respectively. The scores concerning self-esteem, lack of family support, financial problems, disturbed schedule, and health problems were 4.32 ± 0.53, 2.24 ± 0.79, 2.84 ± 1.14, 3.63 ± 0.77, and 2.44 ± 0.95, respectively. ICs with higher Activities of Daily Living Scale (ADLS) scores were associated with a lower risk of insomnia, with an odd ratio (OR) and 95% confidence interval (CI) of 0.940 (0.898–0.983). Among the ICs, female gender (OR = 2.597), alcohol consumption (OR = 3.745), underlying medical conditions (OR = 11.765), long-term caregiving experience (OR = 37.037), and higher monthly expenses (OR = 5.714) were associated with a high risk of insomnia. ConclusionOf the hospitalized patients with lung cancer, 51.9% experienced insomnia. Patients’ ADL, ICs gender, alcohol consumption, underlying medical conditions, caregiving duration, and monthly expenses were influencing factors. Therefore, prompt screening and early intervention for ICs of patients with lung cancer is necessary.

Prevalence, diagnosis, and treatment of chronic obstructive pulmonary disease in a hospitalized lung cancer population: a single center study.

Chronic obstructive pulmonary disease (COPD) often coexists with lung cancer (LC) and has a detrimental effect on the prognosis of LC patients. Presently, there is a lack of adequate assessment regarding the management of COPD in LC patients. This study assessed the screening, prevalence, diagnosis and treatment of COPD in hospitalized LC patients and compared the management practices between two departments at our hospital. We retrospectively assessed the data of 3,578 patients diagnosed with primary LC in the Department of Respiratory and Critical Care Medicine and the Department of Thoracic Surgery from January 2019 to December 2020. We also compared the rate of spirometry, COPD diagnosis and COPD inhalation treatment between the LC patients from both departments, the proportion of patients aware of their COPD diagnosis and adhered to inhaled therapy, and analyzed factors influencing COPD diagnosis and inhalation treatment. A total of 2,762 (77.2%) LC patients underwent spirometry, and the observed spirometry-defined COPD prevalence was 25.0% (690/2,762). The proportion of spirometry performed in the Department of Thoracic Surgery was significantly higher than in the Department of Respiratory and Critical Care Medicine (90.5% vs. 62.9%; P<0.001). The overall COPD diagnosis rate recorded in the discharge diagnosis in the 690 spirometry-defined COPD patients was 46.5% (321/690), and the COPD treatment rate during hospitalization was 45.2% (312/690). In addition, physicians from the Department of Respiratory and Critical Care Medicine had a higher diagnostic rate than surgeons from the Department of Thoracic Surgery (69.1% vs. 7.5%; P<0.001), as well as a better-standardized COPD treatment rate (60.6% vs. 18.6%; P<0.001). Further, the proportion of COPD inhalation treatment was higher among LC patients with COPD recorded in discharge diagnosis (74.8% vs. 19.5%; P<0.001), and multivariate logistic regression analysis showed that COPD recorded in discharge diagnosis significantly increased the proportion of COPD awareness post-hospitalization (P<0.001). This study showed that COPD could be a frequently undiagnosed and undertreated condition among LC patients, especially those hospitalized in a surgical ward. Additionally, a discharge diagnosis of COPD may increase the rate of inhalation treatment and awareness of the condition in LC patients.

Potential Drug-Drug Interactions Between Anti-Cancer Drugs and Other Medications in Lung Cancer Patients: A Retrospective Study.

Cancer patients are more vulnerable to developing drug-drug interactions as multiple medications are administered concomitantly with cytotoxic agents to treat the underlying comorbidities. These drug-drug interactions often receive less medical attention and consequently are associated with adverse clinical outcomes. We intended to comprehensively characterize the drug-drug interactions among anticancer drugs and other concomitantly prescribed drugs in hospitalized lung cancer patients. A retrospective, observational, single-centre study was conducted on lung cancer inpatients from the medical records department of Kasturba Hospital, Manipal, India. Drug-drug interactions were identified using the drug interaction checkers of two drug information databases, Micromedex and Epocrates. These drug-drug interactions were categorized based on the source from which they were identified, mechanism, severity/significance, adverse consequences, and management strategies required. Among 196 patients, 555 drug-drug interactions were identified in 185 patients using Micromedex and Epocrates. Based on the mechanism of action, 74% and 22% of the drug-drug interactions were classified as pharmacodynamic and pharmacokinetic respectively. 112 drug-drug interactions were recorded from Micromedex alone, while 549 interactions were found using Epocrates. The oral chemotherapeutic drug gefitinib was found to be associated with the highest number of drug-drug interactions. Drug-drug interactions were highly prevalent among hospitalized lung cancer patients. Structured screening and monitoring for these potentially clinically relevant drug-drug interactions by oncologists in collaboration with clinical pharmacists should be carried out prior to initiation and during anticancer treatment to prevent adverse clinical outcomes.

Clinical spectrum of Chinese hospitalized lung cancer patients with concomitant interstitial lung disease: before and after the new era of LC treatment.

This study aimed to explore the general characteristics and spectrum of hospitalized Chinese patients suffering from lung cancer with concomitant interstitial lung disease (LC-ILD). Furthermore, we compared their features before and after the period of immunotherapy for lung cancer. A retrospective analysis of the clinical characteristics of hospitalized LC patients with definite pathological diagnoses was performed from 2014 to 2021. ILD was defined after the review of chest CT imaging. There were 13,085 hospitalized LC patients. Among them, 509 patients (3.89%) had 551 cases of ILD. There were variable underlying causes of ILD, including idiopathic interstitial pneumonia (360 patients), LC treatment-associated ILD (134 cases), and connective tissue disease-associated ILD (55 patients). Although most LC-ILD patients were suffering from adenocarcinoma (204/40.1%), SCLC patients were prone to concomitant ILD (10.8% of all SCLC cases), followed by SCC (9.6% of all SCC cases). All but 10 LC-ILD patients received anti-LC treatment; however, only 39 (10.8%) LC-IIP patients received anti-ILD treatment. There were more LC-ILD patients in the 2018-2021 group than in the 2014-2017 group (5.16% vs. 2.03%, p < 0.001). The underlying causes of ILD were significantly different between the 2018-2021 group and the 2014-2017 group (p < 0.001). After adjusting forthe number of hospitalized patients having the same LC pathological pattern, SCLC was determined to be the most likely to be concomitant with ILD, followed by SCC. Most LC-ILD patients were scheduled for anti-LC therapy; however, treatments for concomitant IIP were usually ignored. LC treatment-associated ILD should receive more attention than before.

1099P Front-line liquid biopsy for early molecular assessment and treatment of hospitalized lung cancer patients

Molecular characterization of tumor samples has become pivotal in the management of patients affected by non-small cell lung cancer (NSCLC), although this process is often time-consuming. Some lung neoplasms are initially detected after hospitalization through the First Aid Department and the performance status of new patients might worsen while molecular analyses are processed. The primary aim of this ongoing study is to evaluate the performance of “up-front” next-generation sequencing (NGS) through liquid biopsy of hospitalized patients with newly detected lung neoplasm in parallel with conventional diagnosis. We aim to enroll 30 consecutive patients, irrespective of smoking history, immediately after detection of symptomatic, locally advanced or metastatic lung neoplasm. Liquid biopsy from peripheral blood is performed at baseline, in parallel with conventional biopsy, when feasible. Additionally, liquid biopsies are repeated during treatment and at progression in patients with any molecular alteration at baseline. Oncomine™Lung cfTNA Research Assay or Oncomine™Lung cfDNA panels are employed for processing plasma samples in NGS. Between January and May 2022, we recruited 18 hospitalized patients. Liquid biopsy NGS identified five EGFR activating mutations, one ALK rearrangement, five KRAS mutations and one ERBB2 mutation. Median time to results of liquid biopsy was 8 days (5-15) compared to 17 (8-34) by conventional biopsy. Liquid biopsy and conventional biopsy were consistent in all cases apart from one patient who was wild type at liquid biopsy and harbored EGFR exon 19 deletion at tissue biopsy. Four patients with actionable oncogenic drivers at liquid biopsy (one ALK rearrangement, two EGFR mutations and one ERBB2 mutation) could not undergo conventional biopsies due to clinical contraindications. Front-line liquid biopsy might improve the management of symptomatic, hospitalized patients with lung cancer, potentially leading to early start of targeted therapy. Enrollment and longitudinal monitoring of oncogenic drivers with liquid biopsy are ongoing.

Assessment of medication adherence, medication safety awareness and medication practice among patients with lung cancer: A multicentre cross-sectional study.

ObjectivesWe aimed to explore the current status of medication adherence, safety awareness and practice among patients with lung cancer.MethodsWe conducted a questionnaire‐guided cross‐sectional study in Xi'an, Yulin, Hanzhong and Weinan in Shaanxi Province, China, from April to June 2021 for a period of 3 months. The study questionnaire was developed according to previous related studies reported in the literature, and includes basic demographic information and patients' medication safety questions. The data were double‐entered using EpiData 3.1 software; descriptive statistics, t‐test, analysis of variance, the Kruskal–Wallis test and the Mann–Whitney U‐test were performed to analyse the data.ResultsA total of 567 participants were included, and 409 valid questionnaires were finally completed, with an effective response rate of 72.13%. More than 80% of patients showed good medication adherence; the average adherence score was 22 ± 2.68 of 25. The average score for medication safety awareness was 16.40 ± 4.41, which was significantly lower than that of medication adherence (p < .001). Only 22.74% of patients always checked their medicines before a nurse administered them; 17.60% of patients never checked their medicines. Few patients actively consulted an health care professional to understand safety information before taking a medication. A significant difference existed in safety awareness scores among age groups (p = .039) and geographic regions (p < .001). Patients with three or more comorbidities had the lowest awareness scores (p = .027).ConclusionWe found that patients with lung cancer showed better medication adherence, but their awareness about medication safety was poor. Older patients, those with comorbidities and patients in regions with poor medical resources may have worse awareness about safety. Current medication education for patients should not only aim to improve adherence but should also encourage patients to take greater responsibility for their own safety and to actively participate in their medication safety. Greater systematic and individualized medication safety information is needed for older patients, those with more comorbidities and patients in areas with poor medical resources.Patient ContributionWe conducted a questionnaire‐guided cross‐sectional study on hospitalized lung cancer patients in Shaanxi Province to explore the patients' practices related to safety medication, including medication adherence and medication safety awareness.

The Predictive Value of Stair Climbing Test on Postoperative Complications in Lung Cancer Patients with Limited Pulmonary Function.

To evaluate the predictive value of stair climbing test (SCT) on postoperative complications in lung cancer patients with limited pulmonary function. A total of 727 hospitalized lung cancer patients with limited pulmonary function were retrospectively reviewed. Included in the cohort were 424 patients who underwent SCT preoperatively. Patients were grouped according to general condition, past medical history, surgical approach, pulmonary function test, and SCT results. Comparison of the postoperative cardiopulmonary complication rates was made and independent risk factors were identified. A total of 89 cardiopulmonary-related complications occurred in 69 cases, accounting for 16.3% of the entire cohort. The postoperative cardiopulmonary complication rates were significantly different between groups stratified by smoking index, percentage of forced expiratory volume in one second, percentage of diffusion capacity for carbon monoxide, SCT results, excision extension, and anesthetic duration (p <0.05). Multivariate analysis showed that only height achieved (p <0.001), changes in heart rate (∆HR; p <0.001), and excision extension (p = 0.006) were independent risk factors for postoperative cardiopulmonary complications. The SCT could be used as a preoperative screening method for lung cancer patients with limited pulmonary function. For those patients who could only climb less than 6 floors or had ∆HR >30 bpm in the test, sublobar resection should be selected to reduce the postoperative cardiopulmonary complication rate.

Risk factors for in‐hospital mortality in patients with advanced lung cancer with interstitial pneumonia undergoing systemic chemotherapy: A retrospective and observational study using a nationwide administrative database in Japan

BackgroundThe safety profile of systemic chemotherapy for lung cancer patients with interstitial pneumonia (IP) in clinical practice remains unclear. Using Diagnostic Procedure Combination (DPC) data from the Japanese administrative database, we investigated the mortality of hospitalized lung cancer patients with IP as they underwent a course of systemic chemotherapy nationwide.MethodsThe DPC data of patients with stage IIIB or IV lung cancer as defined by the Union for International Cancer Control Tumor‐Nodes‐Metastases 6th and 7th editions from April 2014 to March 2016 were obtained. Among those patients, only patients with concomitant IP and receiving systemic chemotherapy without radiotherapy were included.ResultsAmong 1524 included patients, 70 (4.6%) died in the hospital. Multivariate analysis revealed that low activities of daily living (ADL) scores on admission (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.24–4.12, p = 0.008) and high‐dose corticosteroid therapy following chemotherapy (HR 2.62, 95% CI 1.44–4.77, p = 0.002) were strongly associated with in‐hospital mortality. It was determined that patients possibly received high‐dose corticosteroids for IP exacerbations; these patients had a higher in‐hospital mortality rate of 67.7% (21/31 patients) and a significantly shorter median survival time of 55 days (95% CI 31–69 days, p < 0.001) than those who did not receive high‐dose corticosteroids.ConclusionAcute exacerbation of IP treated with systemic high‐dose corticosteroids is significantly associated with in‐hospital mortality, and a low ADL score on admission is a risk factor for in‐hospital mortality in lung cancer patients with IP who undergo systemic chemotherapy.

Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis.

The use of molecular biomarkers to guide lung cancer management has led to increasing frequency and amounts of tissue required for repeat lung biopsies. While patient safety and reporting of adverse events has been increasingly emphasized in recent decades, the safety of lung biopsies in patients with lung cancer has only been studied in small cohorts. We therefore analyzed adverse events in patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database. Data were abstracted using ICD-9 lung cancer diagnosis (162.X) and lung biopsy procedure codes (33.20, 33.24, 33.25, 33.26, 33.27, 33.28) from 2001 to 2010. Agency for Healthcare Research and Quality (AHRQ) Patient-Safety Indicators (PSI) were used to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4. A total of 540,747 patients were included for analysis. The number of biopsies increased over time, from 51,221 in 2001, to 63,239 in 2010 (P < 0.001). Overall, 159,683 (30%) patients suffered ≥ 1-PSI event during their hospitalization. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients with ≥ 1 PSI event increased from 24% in 2001 to 38% in 2010 (P < 0.001). Patients with ≥ 1 PSI had longer length of stay (mean, 11.6 vs 8.1days; P < 0.001) and higher in-hospital mortality (adjusted odds ratio, 5.9, 95% CI 3.9-8.9; P < 0.001). The frequency of lung biopsies performed and rate of documented adverse events in hospitalized lung cancer patients have increased. These findings have policy, funding, research, and practice implications.

PMU31 ANALYSIS OF RISK FACTORS ASSOCIATED WITH INFECTION AND MORTALITY AMONG HOSPITALIZED LUNG CANCER PATIENTS

Lung cancer is the second most common cancer and the leading cause of death in the United States among older people. Cancer and cancer treatments increase the vulnerability of patients to acquire a bacterial infection due to immunosuppression. These infections may complicate the patient’s condition and result in death. Age, gender, race, and comorbidities may also influence these complications. The aim of this study was to explore the risk of infections among hospitalized lung cancer patients and the association between mortality and infection. Data were obtained from the NIS 2009-2014 datafiles. Patients ≥ 50 years old were included in the study. ICD-9 codes were used to identify hospitalized patients with lung cancer, infection, and to calculate the Charlson Comorbidity Score (CCI). Descriptive statistics were used to identify the characteristics of the study population. Logistic regressions were used to explore the association between mortality, infection, and risk factors (age, gender, race, and CCI). Of the 22,368 identified hospitalized lung cancer patients, 990 had a secondary diagnosis of infection. Among the study population, 3,181 died during hospitalization, 140 were in patients that acquired an infection. The average age among patients with infection was 70.92±10.11 years compared to 71.15±10.08 years in patients without infection. logistic regression showed that females had a 26% higher risk of acquiring an infection among lung cancer patients after adjusting for age and race. Patients that had a CCI score ≥ 4 were more likely to acquire an infection (OR= 1.62; 95% CI [1.33-1.97]). Regarding mortality, there was no association between infection and death after controlling for risk factors. Older patients and males had higher risk of death, while patients with greater CCI scores, Blacks, and Hispanics had lower risk of death. Providers may consider risk factors among hospitalized patients to prevent acquiring infections and decrease mortality rates.

MA14.02 Use and Impact of A Systematic Advanced Care Planning in Hospitalized Lung Cancer Patients: A Prospective Study

MA14.02 Use and Impact of A Systematic Advanced Care Planning in Hospitalized Lung Cancer Patients: A Prospective Study

Prevalence of nutritional risk and malnutrition in hospitalized patients with different stages of lung cancer in a tertiary hospital in Chongqing: a cross-sectional survey

Objective To investigate the prevalence of nutritional risk and malnutrition in hospitalized lung cancer patients in a tertiary A hospital in Chongqing. Methods From December 2013 to July 2017, 2 735 consecutive lung cancer patients were admitted to the Department of Pneumology at Daping Hospital for planned anti-cancer treatment. Patients who did not complete a nutritional status assessment and who had repeated admission were excluded from the study. The demographic and tumor characteristics were investigated in the 548 lung cancer inpatients who completed the study. The nutritional risk screening 2002 (NRS 2002) was used to evaluate the nutritional risk. The individual nutritional status was also evaluated using the patient-generated subjective global assessment (PG-SGA) questionnaire, anthropometry measurements and hematological measurements. The physical status was assessed by the Karnofsky performance status (KPS). Results According to the NRS 2002 score, 29.56% (162/548) of the cancer patients had nutritional risk (score ≥3). The prevalence of nutritional risk was 17.39%, 15.00%, 22.00% and 36.86%, respectively, for patients with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ lung cancer. Forty-four patients (9.67%) had a body mass index<18.5 kg/m2 and poor general condition, and the prevalence was 6.52%, 5.00%, 8.67% and 11.22%, respectively, for stages Ⅰ, Ⅱ, Ⅲ and Ⅳ. A total of 107 cases (19.53%) had impaired nutritional status (indicated by a severity score of 3 in the NRS 2002). The prevalence by different stages was 10.87% (stage Ⅰ), 5.00% (stage Ⅱ), 14.67% (stage Ⅲ) and 25.00% (stage Ⅳ). One hundred and twenty-five patients (22.81%) had PG-SGA scores ≥9, with 2.19%, 2.50%, 12.67%, and 33.33% of patients in stages Ⅰ, Ⅱ, Ⅲ and Ⅳhaving these high scores. The KPS scores were lower in the patients with nutritional risk and malnutrition than in the patients with a normal nutritional status. Conclusions The prevalence of nutritional risk and malnutrition in patients with lung cancer were medium. Nutritional risk screening and nutritional status assessment should be considered at the time of admission for lung cancer patients in order to ensure better outcomes of treatment. Key words: Lung cancer; Cancer stage; Nutritional risk screening 2002; Nutritional status assessment; Patient-generated subjective global assessment; Malnutrition

Prognostic factors of noninvasive mechanical ventilation in lung cancer patients with acute respiratory failure.

IntroductionFew studies have reported outcomes of lung cancer patients with acute respiratory failure (RF) using noninvasive positive pressure ventilation (NIPPV). The aim of this study was to investigate the prognostic factors in these patients.Materials and methodsThis retrospective observational study included all hospitalized lung cancer patients who received NIPPV for acute RF. It was conducted at a tertiary medical center in Taiwan from 2005 to 2010. The primary outcome was all cause mortality at 28 days after the initiation of NIPPV. Secondary outcomes included all-cause in-hospital mortality, weaning from NIPPV, intubation rate, tracheostomy rate, duration of NIPPV, hospital stay and intensive care unit stay.ResultsThe all-cause mortality rate at day 28 of the enrolled 58 patients was 39.66%. The 90-day and 1-year mortality rates were 63.79% and 86.21%, respectively. NIPPV as the first line therapy for RF had higher 28-day mortality rate than it used for post-extubation RF (57.6% versus 16.0%, p<0.05). Independent predictors of mortality at 28 days were progressive disease or newly diagnosed lung cancer (OR 14.02 95% CI 1.03–191.59, p = 0.048), combined with other organ failure (OR 18.07 95% CI 1.87–172.7, p = 0.012), and NIPPV as the first line therapy for RF (OR 35.37 95% CI 3.30–378.68, p = 0.003).ConclusionLung cancer patients using NIPPV with progressive or newly diagnosed cancer disease, combined with other organ failure, or NIPPV as the first line therapy for respiratory failure have a poor outcome.

P1.06-011 Hyponatremia - Evaluation of Prevalence in Hospitalized Lung Cancer Patients and Its Prognostic Significance

P1.06-011 Hyponatremia - Evaluation of Prevalence in Hospitalized Lung Cancer Patients and Its Prognostic Significance

PHS124 - Differences in Characteristics, Health service Utilization and cost between older Hospitalized Lung Cancer Patients with or without Asthma

PHS124 - Differences in Characteristics, Health service Utilization and cost between older Hospitalized Lung Cancer Patients with or without Asthma