Predictors of Unplanned Hospitalizations Among Older Adults Receiving Cancer Chemotherapy
Predictors of Unplanned Hospitalizations Among Older Adults Receiving Cancer Chemotherapy
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DOI：
10.1200/op.20.00681
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发表时间：
2021-06-01
影响因子：
4
通讯作者：
Dale, William
中科院分区：
文献类型：
--
作者：
Klepin, Heidi D.;Sun, Can-Lan;Dale, William
目的：癌症治疗期间的住院费用高昂，会降低生活质量，并对治疗完成情况产生负面影响。我们的目的是确定接受化疗的老年人中非计划性住院的风险因素。
方法：这是一项对多中心队列研究（N = 750）的二次分析，该研究对≥65岁的患者进行了老年评估（GA）以预测化疗毒性。本次分析的主要结局是治疗期间的非计划性住院；次要结局是首次住院的住院时间（LOS）。自变量包括治疗前的老年评估指标、实验室数值、癌症类型和分期以及治疗强度特征。我们在多变量分析中使用逻辑回归来估计住院的几率，并使用广义线性模型来分析住院时间。
结果：样本的中位年龄为72岁（范围，65 - 94岁）；59%患有IV期疾病。在接受化疗期间，193名患者（25.7%）至少发生了一次非计划性住院。在控制癌症类型的多变量分析中，以下基线特征与住院几率增加显著相关：洗澡或穿衣需要帮助（优势比[OR]，1.8；95%置信区间，1.0 - 3.1）、多重用药（≥5种药物）（OR，1.6；95%置信区间，1.1 - 2.4）、更多的合并症（OR，1.1；95%置信区间，1.0 - 1.3）、有人可带其就医（OR，2.0；95%置信区间，1.0 - 4.1）、肌酐清除率<60 mL/min（OR，1.7；95%置信区间，1.1 - 2.4）以及白蛋白<3.5 g/dL（OR，1.8；95%置信区间，1.2 - 2.8）。在多变量分析中，年龄较大、自述有肝脏或肾脏疾病、独居以及抑郁症状与较长的住院时间相关。
结论：容易获取的老年评估变量和实验室数据，而非年龄，与接受化疗的老年人非计划性住院相关。如果得到验证，这些数据可以为预测模型和减少非计划性住院的干预措施设计提供信息。
PURPOSE: Hospitalizations during cancer treatment are costly, can impair quality of life, and negatively affect therapy completion. Our objective was to identify risk factors for unplanned hospitalization among older adults receiving chemotherapy. METHODS: This is a secondary analysis of a multisite cohort study (N = 750) of patients >= 65 years of age evaluated with a geriatric assessment (GA) to predict chemotherapy toxicity. The primary outcome of this analysis was unplanned hospitalizations during treatment; the secondary outcome was length of stay (LOS) of the first hospitalization. Independent variables included pretreatment GA measures, laboratory values, cancer type and stage, and treatment intensity characteristics. We used logistic regression to estimate the odds of hospitalization and generalized linear models for LOS in multivariable analyses. RESULTS: The sample median age was 72 years (range, 65-94 years); 59% had stage IV disease. At least one unplanned hospitalization occurred in 193 patients (25.7%) during receipt of chemotherapy. In multivariable analyses controlling for cancer type, the following baseline characteristics were significantly associated with increased odds of hospitalization: needing help bathing or dressing (odds ratio [OR], 1.8; 95% CI, 1.0 to 3.1), polypharmacy (>= 5 meds) (OR, 1.6; 95% CI, 1.1 to 2.4), more comorbid conditions (OR, 1.1; 95% CI, 1.0 to 1.3), availability of someone to take them to the doctor (OR, 2.0; 95% CI, 1.0 to 4.1), CrCl < 60 mL/min (OR, 1.7; 95% CI, 1.1 to 2.4), and albumin < 3.5 g/dL (OR, 1.8; 95% CI, 1.2 to 2.8). In multivariable analyses, older age, self-reported presence of liver or kidney disease, living alone and depressive symptoms were associated with longer LOS. CONCLUSION: Readily available GA variables and laboratory data, but not age, were associated with unplanned hospitalizations among older adults receiving chemotherapy. If validated, these data can inform prediction models and the design of interventions to decrease unplanned hospitalizations.