Examining inpatient chemotherapy utilization among patients with cancer and impact on outcomes

BACKGROUND: With the adoption of safer outpatient cancer care practices, much of cancer care has transitioned to outpatient settings, decreasing the need for inpatient systemic therapy (IST), which is associated with poorer end-of-life outcomes. We evaluated reasons for IST use, palliative care (PC) utilization, and outcomes among IST recipients to inform guidelines on appropriate IST use. MATERIALS AND METHODS: We conducted a retrospective chart review of all IST admissions at an academic center from January 2016 to December 2017. Patients were stratified by solid tumor (ST) vs hematological malignancies (HM). We recorded IST urgency, response, mortality, and other variables. Descriptive statistics and odds ratios were estimated from logistic regression models with mixed effects to account for multiple admissions per patient. RESULTS: We analyzed 893 admissions (19% ST) among 620 patients. HM patients required frequent elective IST admissions than ST (P < .0001). ST patients more often received IST for non-urgent indications (P = .0032) during non-cancer-related admissions. ST patients had fewer responses to IST compared to HM (36% vs 70%; P < .0001). PC services were more likely utilized for ST vs HM patients (48% vs 14%; P < .0001) and were associated with increased rates of health care proxy assignment, code status change, and hospice discharge. Early 60-day mortality was higher for ST vs HM patients (17.3% vs 5.8%; P < .001), and most patients (55%) died inpatient during the index admission. CONCLUSION: IST was overutilized in ST patients with poor response rates and significant early mortality. PC service utilization rates remain low but improved end-of-life transition planning.