Predictors of unplanned hospitalizations in patients with nonmetastatic lung cancer during chemotherapy

Kristen L. Fessele, Matthew J. Hayat, Robert Atkins

Publication Date: 09/01/2017

Purpose/Objectives: To determine predictors of unplanned hospitalizations in patients with lung cancer to receive chemotherapy in the outpatient setting and examine the potential financial burden of these events.

Design: Retrospective, longitudinal cohort study. Setting: The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Sample: Of 104,388 incident cases of lung cancer diagnosed from 2005-2009, 2,457 cases of patients with lung cancer who received outpatient chemotherapy were identified. Patients were aged 66 years or older at diagnosis, had uninterrupted Medicare Part A and B coverage with no health maintenance organization enrollment, and received IV chemotherapy at least once.

Methods: Generalized estimating equations was used. Main Research Variables: Patient age, sex, race, marital status, degree of residential urbanization, median income, education level, stage, receipt of radiation therapy, and comorbidities.

Findings: Younger age, non-White race, lower education, higher income, receipt of radiation therapy, and lack of preexisting comorbidity were significant predictors of the likelihood of an initial unplanned hospitalization for lung cancer. Non-White race, receipt of radiation therapy, and comorbidity were factors associated with an increased number of hospitalizations. Conclusions: Unplanned hospitalizations are frequent, disruptive, and costly. This article defines areas for further exploration to identify patients at high risk for unexpected complications. Implications for Nursing: This article represents a foundation for development of risk models to enable nursing evaluation of patient risk for chemotherapy treatment interruption and unplanned hospitalization.