Assessing lung cancer patients' unplanned hospitalizations, a cohort study to find care gaps: Tracking what is trackable

There is growing interest in unplanned hospital admissions (UHA) in lung cancer (LC) to understand morbidity and identify gaps in cancer care. Despite being easily measurable, data is limited and heterogeneous. We conducted a retrospective observational study selecting all LC patients treated at the Medical Oncology Department of Puerta de Hierro University Hospital between 2016 and 2020. Data cut-off was June 30, 2021. Our goal was to assess the risk of UHA and to evaluate quality of care with length of stay (LOS), mortality and readmissions as indicators. Between 2016 and 2020, 821 LC patients were evaluated (median follow-up of 32.8 months). 503 patients (61.3%) had an UHA, 48.6% of patients hospitalized in the first year after first consultation at Medical Oncology. Among 1418 admissions, 1186 (83.6%) were UHA. Multivariate analysis showed an increased risk of UHA for locally advanced, HR 1.62 (95% CI: 1.05 – 2.50; p=0.03), and for advanced disease, HR 2.19. (95% CI: 1.43 – 3.33; p<0.001); compared to local disease. There was an increase for ECOG 2 vs 0, HR 1.92 (95% CI: 1.34 – 2.75), male sex, HR 1.30 (95% CI: 1.03 – 1.65), and smokers, HR 1.78 (95% CI: 1.15 – 2.75). No association with age or histology was found. Comparing quality indicators for scheduled vs UHA: median LOS were 3 days (IQR: 1 – 6.6) and 6 days (IQR_ 3 - 10), mortality rate were 4.5% and 17.3%, and readmissions in the first week were 3% and 6.5% respectively. Table: 1604PCumulative incidence (95%CI) for UHA over timeLocal diseaseLocally advancedMetastatic3 months13% (0.07 – 0.20)23% (0.17 – 0.29)34% (0.30 – 0.39)6 months18% (0.11 – 0.26)31% (0.24 – 0.37)45% (0.40 – 0.49)12 months22% (0.15 – 0.31)41% (0.33 – 0.48)58% (0.53 – 0.63) Open table in a new tab 61.3% of LC patients suffered an UHA, 48.6% of patients in the first year after the first oncology visit. Locally advanced and advanced disease were associated with an increased risk of UHA, HR 1.62 and 2.19 respectively, ECOG 2, male sex and smoking were also associated with increased risk. Quality indicators as LOS, mortality and readmissions reflect a more difficult scenario than a scheduled care. Our study shows that UHA are a major problem and should be measured to optimize the continuity of care and a better quality of life for LC patients.