Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 300 Mason Lord Drive, Baltimore, MD, 21224, USA.
Department of Oncology, Biostatistics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMC Cancer. 2020 Apr 19;20(1):334. doi: 10.1186/s12885-020-06843-z.
Unplanned hospitalization during cancer treatment is costly, can disrupt treatment, and affect patient quality of life. However, incidence and risks factors for hospitalization during lung cancer radiotherapy are not well characterized.
Patients treated with definitive intent radiation (≥45 Gy) for lung cancer between 2008 and 2018 at a tertiary academic institution were identified. In addition to patient, tumor, and treatment related characteristics, specific baseline frailty markers (Charlson comorbidity index, ECOG, patient reported weight loss, BMI, hemoglobin, creatinine, albumin) were recorded. All cancer-related hospitalizations during or within 30 days of completing radiation were identified. Associations between baseline variables and any hospitalization, number of hospitalizations, and overall survival were identified using multivariable linear regression and multivariable Cox proportional-hazards models, respectively.
Of 270 patients included: median age was 66.6 years (31-88), 50.4% of patients were male (n = 136), 62% were Caucasian (n = 168). Cancer-related hospitalization incidence was 17% (n = 47), of which 21% of patients hospitalized (n = 10/47) had > 1 hospitalization. On multivariable analysis, each 1 g/dL baseline drop in albumin was associated with a 2.4 times higher risk of any hospitalization (95% confidence interval (CI) 1.2-5.0, P = 0.01), and baseline hemoglobin ≤10 was associated with, on average, 2.7 more hospitalizations than having pre-treatment hemoglobin > 10 (95% CI 1.3-5.4, P = 0.01). After controlling for baseline variables, cancer-related hospitalization was associated with 1.8 times increased risk of all-cause death (95% CI: 1.02-3.1, P = 0.04).
Our data show baseline factors can predict those who may be at increased risk for hospitalization, which was independently associated with increased mortality. Taken together, these data support the need for developing further studies aimed at early and aggressive interventions to decrease hospitalizations during treatment.
癌症治疗期间的非计划性住院治疗费用高昂，会中断治疗并影响患者的生活质量。然而，肺癌放疗期间住院的发生率和风险因素尚未得到很好的描述。
在一家三级学术机构接受明确放疗（≥45Gy）的肺癌患者在 2008 年至 2018 年间被确定。除了患者、肿瘤和治疗相关特征外，还记录了特定的基线脆弱性标志物（Charlson 合并症指数、ECOG、患者报告的体重减轻、BMI、血红蛋白、肌酐、白蛋白）。确定了所有与癌症相关的住院治疗，这些治疗是在放疗期间或放疗结束后 30 天内发生的。使用多变量线性回归和多变量 Cox 比例风险模型分别确定基线变量与任何住院治疗、住院次数和总生存之间的关联。
在 270 名患者中：中位年龄为 66.6 岁（31-88 岁），50.4%的患者为男性（n=136），62%为白种人（n=168）。癌症相关住院治疗的发生率为 17%（n=47），其中 21%的患者（n=47/224）住院治疗>1 次。多变量分析显示，白蛋白基线每下降 1g/dL，任何住院治疗的风险增加 2.4 倍（95%置信区间（CI）为 1.2-5.0，P=0.01），基线血红蛋白≤10 与治疗前血红蛋白>10 的患者相比，平均多住院治疗 2.7 次（95%CI 为 1.3-5.4，P=0.01）。在控制基线变量后，癌症相关住院治疗与全因死亡风险增加 1.8 倍相关（95%CI：1.02-3.1，P=0.04）。
我们的数据表明，基线因素可以预测那些可能有更高住院风险的患者，而这些患者的住院治疗与死亡率的增加独立相关。综上所述，这些数据支持需要进一步研究旨在早期和积极干预以减少治疗期间的住院治疗。
