Identification and Characterization of Avoidable Hospital Admissions in Patients With Lung Cancer
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Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee
Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC) and Medicine Services, Nashville, Tennessee
Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Background: More than 50% of patients with lung cancer are admitted to the hospital while receiving treatment, which is a burden to patients and the healthcare system. This study characterizes the risk factors and outcomes of patients with lung cancer who were admitted to the hospital. Methods: A multidisciplinary oncology care team conducted a retrospective medical record review of patients with lung cancer admitted in 2018. Demographics, disease and admission characteristics, and end-of-life care utilization were recorded. Following a multidisciplinary consensus review process, admissions were determined to be either “avoidable” or “unavoidable.” Generalized estimating equation logistic regression models assessed risks and outcomes associated with avoidable admissions. Results: In all, 319 admissions for 188 patients with a median age of 66 years (IQR, 59–74 years) were included. Cancer-related symptoms accounted for 65% of hospitalizations. Common causes of unavoidable hospitalizations were unexpected disease progression causing symptoms, chronic obstructive pulmonary disease exacerbation, and infection. Of the 47 hospitalizations identified as avoidable (15%), the median overall survival was 1.6 months compared with 9.7 months (hazard ratio, 2.07; 95% CI, 1.34–3.19; P<.001) for unavoidable hospitalizations. Significant reasons for avoidable admissions included cancer-related pain (P=.02), hypervolemia (P=.03), patient desire to initiate hospice services (P=.01), and errors in medication reconciliation or distribution (P<.001). Errors in medication management caused 26% of the avoidable hospitalizations. Of admissions in patients receiving immunotherapy (n=102) or targeted therapy (n=44), 9% were due to adverse effects of treatment. Patients receiving immunotherapy and targeted therapy were at similar risk of avoidable hospitalizations compared with patients not receiving treatment (P=.3 and P=.1, respectively). Conclusions: We found that 15% of hospitalizations among patients with lung cancer were potentially avoidable. Uncontrolled symptoms, delayed implementation of end-of-life care, and errors in medication reconciliation were associated with avoidable inpatient admissions. Symptom management tools, palliative care integration, and medication reconciliations may mitigate hospitalization risk.
Submitted January 12, 2023; final revision received May 24, 2023; accepted for publication June 22, 2023.
Author contributions: Conceptualization: Lander, Huang, Cass, Iams, Skotte, Ramirez, Shyr, Horn. Data curation: Lander, Huang, Cass, Skotte, Whisenant, York, Osterman, Lewis, Lovly, Shyr, Horn. Formal analysis: Lander, Li, Huang, Cass, Skotte, Shyr, Horn. Methodology: Lander, Li, Huang, Cass, Iams, Skotte, Whisenant, Ramirez, Osterman, Lewis, Shyr, Horn. Project administration: Lander, Whisenant, Osterman, Horn. Resources: Lander, Whisenant, Osterman, Horn. Software: Lander, Huang, Whisenant, Osterman, Shyr. Writing—original draft: Lander, Li, Huang, Cass, Skotte, Horn. Writing—review & editing: Lander, Li, Huang, Cass, Iams, Skotte, Ramirez, York, Osterman, Lewis, Lovly, Shyr, Horn.
Disclosures: Dr. Cass has disclosed serving on an advisory board for Regeneron, G1 Therapeutics, and Takeda. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number 5T32CA217834-05 (E. Lander), the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K12HL137943 (J.A. Lewis), Vanderbilt-Ingram Cancer Center (CA68485; J.A. Lewis), LUNGevity VA Research Scholars Award 2021-08 (J.A. Lewis), and an ASCO Conquer Cancer Young Investigator Award (2021YIA-9865677411; J.A. Lewis).
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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