Outcomes of inpatient (IP) systemic cancer therapy in patients (pts) with solid tumors.

Abstract

e23059 Background: Administration of IP cancer therapy requires substantial resources and carries risk of toxicity. Given this, we sought to describe the pts receiving IP cancer therapy at our institution to identify areas for improvement. Methods: We performed a retrospective chart review of adult pts with solid cancer who received unplanned intravenous IP cancer therapy at an academic tertiary care hospital between April and October 2024. Pts with hematologic malignancies or preplanned cancer therapy admissions were excluded. Outcomes included 30-day readmission, receipt of subsequent cancer-directed therapy, and six-month post-discharge hospice enrollment and mortality. Results: 161 pts were included, median age was 60 years, 51% male sex, 76% had metastatic cancer, 46% White and 28% Asian race; most common cancer type was gastrointestinal (42%), and thoracic (12%). 65% of pts were on their first line of therapy. The most common reason for administration was complication of cancer requiring immediate disease control (54%). 52% died from any cause within the following 6 months including 12% (n=20) who died during the index hospitalization. Of the 87 pts receiving therapy for a cancer-related complication, 20% (n=17) died during the hospital stay. Of those (n=70) discharged alive, 33% saw palliative care prior to or during the hospitalization, 24% had an IP goals of care discussion, and 70% were full code on discharge. Further, 70% went on to receive additional cancer treatment post discharge, 41% were readmitted within 30 days, 41% transitioned to hospice within the next 6 months and 49% died from any cause with half of them dying in a subsequent hospitalization. Compared to pts who went on to receive additional cancer treatment, pts treated who did not receive further therapy after discharge were more likely to have metastatic disease (p=0.02) and poor performance status (ECOG 3–4; p=0.01). There was no difference in age or likelihood of having GI cancer or being on salvage therapy (vs front-line therapy). Conclusions: Over a six-month period, nearly one pt per day received unplanned IP cancer therapy and 20% of those who received chemotherapy for cancer-related complications did not survive index hospitalization. Functional status and disease burden preceding IP therapy for cancer-related complications were associated with no further cancer therapy upon discharge, which suggests a population who may be inappropriate for IP therapy. Standardizing criteria for IP cancer therapy could help prevent overuse of this resource-intensive treatment. Baseline characteristics. All patients (N=161) Age, median (IQR), yr 60 (23) Male sex, n (%) 82 (51) Race, n (%) WhiteAsianBlack 74 (46) 45 (28) 4 (2) Cancer type, n (%) a GI Thoracic Breast GU Head/Neck Sarcoma 67 (42) 20 (12) 10 (6) 14 (9) 15 (9) 15 (9)