Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_39_2981 - Acute Hospital Encounters in Cancer Patients Treated with Definitive Radiation Therapy

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Acute Hospital Encounters in Cancer Patients Treated with Definitive Radiation Therapy
M. Marar1, P. E. Gabriel2, W. T. Hwang3, D. R. Owen4, M. Ju5, C. B. Simone II6, J. P. Christodouleas7, N. Vapiwala5, and A. T. Berman2; 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 2University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 3University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA, 4Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 5Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 6Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 7Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA

Purpose/Objective(s): To curb costs and improve quality and coordination in cancer care, policy initiatives such as the Center for Medicare and Medicaid Innovation’s Oncology Care Model have emphasized a reduction in acute hospitalizations. Acute hospital encounters in patients undergoing curative-intent radiotherapy (RT) have not been previously well-characterized. Understanding acute visit patterns among RT patients can inform design of risk assessments and cancer urgent care clinics that could decrease hospitalization rates and reduce healthcare costs. This study aims to identify patient, tumor, and treatment characteristics associated with emergency department (ED) visits and inpatient admissions in cancer patients treated with definitive RT.

Materials/Methods: A retrospective cohort study was conducted using data from a quaternary-care cancer center. The cohort was defined as all consecutive non-metastatic patients ≥ 18 years who began RT between July 1, 2011 and December 31, 2013 who were treated with curative intent. An acute encounter was defined as an ED visit or inpatient admission during RT or within 30 days after the conclusion of RT.

Results: Among 1,852 unique RT courses, 666 RT courses (36.0%) involved at least one acute encounter, and a total of 1,418 acute encounters were identified. Among 699 total ED visits, 34.5% were treated and discharged, whereas 56.8% were admitted. Among 719 total inpatient admissions, approximately 42% resulted in discharge to home health care and 37.8% were discharged to home with self-care. The most common primary diagnosis categories among inpatient admissions were cancer related (19.3%) or infection (18.9%). RT courses with at least one acute encounter corresponded to patients more likely to be on their second (OR 1.96, p < 0.001) or third (OR 3.82, p < 0.05) RT course and undergoing concurrent chemotherapy (OR 6.38, p < 0.001). Of the RT courses with at least one acute encounter, the most common primary cancer type was thoracic (22.8%), followed by head/neck (22.2%) and gastrointestinal (18.3%). Central nervous system tumors had the greatest proportion of RT courses with acute encounters (77.1%). Among ED visits, patients with thoracic tumors were most likely to be admitted (71.3%), followed by those with gastrointestinal tumors (61.5%).

Conclusion: In this retrospective analysis from a quaternary-care cancer center, more than one-third of curative-intent RT courses were associated with at least one acute hospital encounter during or shortly after RT. Given that acute encounters varied by patient, tumor, and treatment characteristics, a predictive risk-stratification algorithm can be constructed from this data. These findings and further large-scale studies analyzing acute hospital encounters among radiation patients can drive development of novel care delivery models that may reduce cancer-related hospitalizations and healthcare costs.

Author Disclosure: M. Marar: None. P.E. Gabriel: Employee; University of Pennsylvania. Member, Oncology Steering Board; Epic Systems, Inc. D.R. Owen: None. M. Ju: None. C.B. Simone: Employee; Nemours/Alfred I. duPont Hospital for Children. Chair, Executive Council; Chair, Lung Committee; Proton Collaborative Group (PCG). Editor-in-Chief; Annals of Palliative Medicine. J.P. Christodouleas: None. N. Vapiwala: Vice Chair; ACGME Residency Review Committee. President; ADROP. A.T. Berman: None.

Mallika Marar, BA

Biography:
Mallika Marar is a student researcher with the Department of Radiation Oncology at the University of Pennsylvania and an MD/MBA Candidate at the Perelman School of Medicine and The Wharton School at the University of Pennsylvania. She has a B.A. in Economics from the University of Pennsylvania. Research interests include health policy and patterns of uptake of novel cancer therapies into clinical practice.

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