Kanemo Philip, Musa Keffi Mubarak, Deenadayalan Vaishali, Litvin Rafaella, Odeyemi Olubunmi Emmanuel, Shaka Abdultawab, Baskaran Naveen, Shaka Hafeez
Department of Internal Medicine, Rapides Regional Medical Center, Alexandria, LA 71301, United States.
Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria 88445, Kaduna, Nigeria.
World J Clin Oncol. 2023 Aug 24;14(8):311-323. doi: 10.5306/wjco.v14.i8.311.
The coronavirus disease 2019 (COVID-19) pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases. However, little focus has been given to its effect on cancer treatment.
To determine the effect of COVID-19 pandemic on cancer patients' care.
A retrospective review of a Nationwide Readmission Database (NRD) was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy (IPCT) during the COVID-19 pandemic in 2020. Two cohorts were defined based on readmission within 30 d and 90 d. Demographic information, readmission rates, hospital-specific variables, length of hospital stay (LOS), and treatment costs were analyzed. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariate Cox regression analysis was performed to identify independent predictors of readmission. Statistical analysis was conducted using Stata Version 16 software. As the NRD data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study.
A total of 87755 hospitalizations for IPCT were identified during the pandemic. Among the 30-day index admission cohort, 55005 patients were included, with 32903 readmissions observed, resulting in a readmission rate of 59.8%. For the 90-day index admission cohort, 33142 patients were included, with 24503 readmissions observed, leading to a readmission rate of 73.93%. The most common causes of readmission included encounters with chemotherapy (66.7%), neutropenia (4.36%), and sepsis (3.3%). Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts. The total cost of readmission for both cohorts amounted to 1193000000.00 dollars. Major predictors of 30-day readmission included peripheral vascular disorders [Hazard ratio (HR) = 1.09, 0.05], paralysis (HR = 1.26, < 0.001), and human immunodeficiency virus/acquired immuno-deficiency syndrome (HR = 1.14, = 0.03). Predictors of 90-day readmission included lymphoma (HR = 1.14, < 0.01), paralysis (HR = 1.21, = 0.02), and peripheral vascular disorders (HR = 1.15, < 0.01).
The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT. These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.
2019年冠状病毒病（COVID-19）大流行因其对医疗系统和各种疾病的影响而在科学界受到了相当大的关注。然而，很少有人关注其对癌症治疗的影响。
确定COVID-19大流行对癌症患者护理的影响。
对全国再入院数据库（NRD）进行回顾性分析，以分析2020年COVID-19大流行期间接受住院化疗（IPCT）患者的住院模式。根据30天和90天内的再入院情况定义了两个队列。分析了人口统计学信息、再入院率、医院特定变量、住院时间（LOS）和治疗费用。使用Elixhauser合并症指数评估合并症。进行多变量Cox回归分析以确定再入院的独立预测因素。使用Stata 16版软件进行统计分析。由于NRD数据是匿名的，不能用于识别患者，因此本研究无需机构审查委员会批准。
在大流行期间共确定了87755例IPCT住院病例。在30天索引入院队列中，纳入了55005例患者，观察到32903例再入院病例，再入院率为59.8%。对于90天索引入院队列，纳入了33142例患者，观察到24503例再入院病例，再入院率为73.93%。最常见的再入院原因包括化疗相关情况（66.7%）、中性粒细胞减少（4.36%）和败血症（3.3%）。在两个再入院队列中，再入院住院病例的合并症明显高于索引住院病例。两个队列的再入院总费用达1193000000.00美元。30天再入院的主要预测因素包括外周血管疾病[风险比（HR）=1.09，P<0.05]、瘫痪（HR = 1.26，P<0.001）和人类免疫缺陷病毒/获得性免疫缺陷综合征（HR = 1.14，P = 0.03）。90天再入院的预测因素包括淋巴瘤（HR = 1.14，P<0.01）、瘫痪（HR = 1.21，P = 0.02）和外周血管疾病（HR = 1.15，P<0.01）。
COVID-19大流行对接受IPCT的患者管理产生了重大影响。这些发现凸显了在大流行期间对接受IPCT的患者采取更具战略性护理方法的迫切需求。
