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Background: Hospitalizations during cancer treatment are common, can impact quality of life and the progress of the treatment. We aimed to investigate the main causes of hospitalizations and factors associated with in-hospital mortality for patients receiving chemotherapy. Methods: This retrospective study included patients (pts) with solid tumors, who received outpatient chemotherapy in the 30-day period before unplanned admission to a cancer center in Brazil, from February to December of 2021. Patients with COVID-19 diagnosis were excluded. We retrieved clinical and laboratory data from health records. Logistic regression univariable and multivariable models were performed to analyze the association of the variables and in-hospital mortality as dependent outcome. Results: 784 pts were included, median age at hospitalization was 60 (IQR 49-68), and 57% were female. Most patients had ECOG 0-1 (61%) and nearly 70% had metastatic disease at admission. The most common primary tumors were colorectal (21.6%), breast (20.1%), lung (8.6%), and gastric (8.6%). Over half (56%) received platin-based regimens, usually in association with fluoropyrimidines or taxanes. Pain (33%), nausea (23%) and fever (16%) were the most referred symptoms at admission. The main diagnosis at were infection (32%), followed by disease progression (DP) (29%), and chemotherapy associated toxicity (26%). A total of 174 (22%) pts required intensive care unit support during hospital stay. The in-hospital overall mortality rate was 18%. Univariable analysis revealed poor ECOG-PS, grade 3 anemia, grade 3 thrombocytopenia and DP associated with in-hospital mortality. In the final multivariable model, ECOG ≥ 2 (OR 1.99, CI 95% 1.33 - 2.99, p <0.001), DP (OR 4.62, CI 95% 3.07 - 7.00, p <0.001) and grade 3 anemia (OR 2.38, CI 95% 1.45 - 3.87, p<0.001) remained statistically associated with in-hospital mortality. Conclusions: A substantial percentage of unplanned admissions after chemotherapy treatment are due to toxicity. Poor performance status, progression of disease on admission and severe anemia are associated with worse in-hospital prognosis. Grade 3 anemia on admission was the only toxicity associated with in-hospital mortality. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: R.C. Bonadio: Personal, Expert Testimony: AstraZeneca, Ache;Personal, Research Grant: Novartis;Personal, Roche. All other authors have declared no conflicts of interest.
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Background: Cancer incidence has increased among adolescents and young adults (AYA) over the last two decades. Younger patients often present with late diagnosis, aggressive disease, and are more likely to receive chemotherapy during cancer treatment. We investigated admission outcomes and postdischarge survival of AYA who were hospitalized after urgent admission. Methods: Retrospective cohort of patients with solid tumor diagnosis and age between 18 and 39 years, hospitalized after urgent admission to a tertiary, publicly-funded, cancer hospital in São Paulo, Brazil, from February 1st to December 31th 2021. We excluded patients with positive COVID-19 RT-PCR. We collected data on gender, cancer diagnosis, length of hospital stay, in-hospital mortality, chemotherapy infusion either before and during hospitalization;and last-follow up date and status. AYA admissions were compared to older adults (≥ 40 years [non-AYA]) admissions with chi-squared test. Overall survival (OS) after discharge between groups was analyzed with the log-rank test. Results: Of 4011 admissions, 312 were AYA. The median age was 34 (IQR 29-38) and most patients were female (63%). Compared to older adults (N = 3699), a higher proportion of AYA patients had breast cancer (25% vs 15%), central nervous system cancer (8.4% vs 2.6%), cervical cancer (12% vs 2.7%) and germinative cancer (4.5% vs 0.3%). The median length of hospital stay was 6 days (IQR 4-10). AYA were more likely to be under chemotherapy treatment during (11% versus 4%, p = 0.001) and within 30 days before hospitalization (32% vs 20%, p = 0.001). The overall in-hospital mortality rate was lower among AYA compared to older adults during the same period (12% vs 20%, p = 0.01). However, of those who died, a higher proportion were prescribed chemotherapy infusion before (38% vs 19%, p = 0.004) and during (15% vs 3.3%, p = 0.003) hospitalization;and a higher number of patients deceased on intensive-care unit beds, although the difference was not statistically significant (46% versus 36%, p = 0.2). Despite similar rates of 30-days readmissions (29% versus 26%, p = 0.3), AYA had better prognosis after discharge (mOS 295 days versus 181 days, p = 0.002). Conclusions: AYA patients had better hospitalization outcomes and were more likely to receive aggressive care near the end of life. Despite similar rates of early (≤ 30 days) readmissions, AYA had higher median overall survival after discharge compared to older adults. These finding should be taken into consideration when discussing hospitalization goals during admission of AYA with cancer.
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Background: Patients with cancer have high mortality during hospitalization and poor prognosis after discharge. However, most evidence comes from developed countries where early diagnosis is common and a higher number of treatment options are available. In addition, socioeconomic disparity is also known to impact on cancer prognosis. We aimed to investigate the impact of hospitalizations, early readmissions, and Human Development Index (HDI) among cancer patients in a public tertiary hospital in Brazil. Methods: A retrospective study was conducted including patients admitted at a Brazilian tertiary cancer center from February 1st to November 30th of 2021. Data was collected from patients' electronic health records. COVID-19 diagnosed patients were excluded. We evaluated 7-day and 30-day readmission rate, and post-discharge survival. We retrieved patients' home address region HDI from the latest Brazilian Census and investigated if it would affect hospitalization and post-discharge outcomes. Overall survival (OS) after discharge was compared between groups with log-rank test and categorical variables proportions with chi-square test. Results: A total of 3711 patients were included during the period. The median age was 64 years (IQR 53-72);nearly half were female (51%). The most common cancer diagnosis was breast cancer (538, 15%) followed by prostate (308, 8.4%), colon (298, 8.1%) and lung (269, 7.3%). The median hospitalization length was 6 days (IQR 4-11). The overall in-hospital mortality rate was 20% (n = 734). Patients initially admitted to the Intensive Care Unit (ICU) had a higher mortality compared to wards (44% vs 17%, p < 0.001). Of those discharged, 9.9% and 28% of the patients were readmitted within 7 and 30 days, respectively. The median overall survival (mOS) of the discharged patients was 182 days (95% CI 160-201 days). Early readmission within 7 and 30 days were associated with poorer overall survival after discharge (Table, p < 0.001). We have not found any association between the HDI and in-hospital mortality, rate of readmissions or overall survival after discharge. Conclusions: Early readmission is an important prognostic factor and should be taken into consideration when discussing post-discharge treatment objectives. HDI does not seem to affect neither hospitalization nor survival outcomes in a publicly funded cancer center.
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OBJECTIVE: To externally validate community acquired pneumonia (CAP) tools on patients hospitalized with COVID-19 pneumonia from two distinct countries, and compare its performance to recently developed COVID-19 mortality risk stratification tools. METHODS: We evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in Sao Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and seven-day intensive-care unit (ICU) admission respectively. We compared their predictive performance using the area under the ROC curve (AUROC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis. RESULTS: Of 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in Sao Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUROCs for PSI (0.79, 95%CI 0.77-0.82), 4C (0.78, 95%CI 0.75-0.81), COVID GRAM (0.77, 95%CI 0.75-0.80), and CURB-65 (0.74 95%CI 0.72-0.77). Results were similar for both countries. For most 1-20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUROC<0.65) for seven-day ICU admission. CONCLUSIONS: Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia assessment tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.