External Validation of Risk Factors for Unplanned Hospitalization in Older Adults With Advanced Cancer Receiving Chemotherapy

Authors:
Mostafa R. Mohamed James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York

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 MBBCh, MSc
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Kah Poh Loh James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York

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 MBBCh BAO, MS
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Supriya G. Mohile James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York

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Michael Sohn Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York

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Tracy Webb Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina

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Megan Wells James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York

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Sule Yilmaz Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, New York

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Rachael Tylock James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York

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Eva Culakova Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, New York

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Allison Magnuson James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York

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Can-Lan Sun City of Hope Comprehensive Cancer Center, Duarte, California

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James Bearden Spartanburg Regional Medical Center, Spartanburg, South Carolina

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Judith O. Hopkins Southeast Clinical Oncology Research Consortium NCORP/Novant Health Cancer Institute, Winston‐Salem, North Carolina

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Bryan A. Faller Missouri Baptist Medical Center, St. Louis, Missouri

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Heidi D. Klepin Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina

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Background: Older adults (age ≥65 years) receiving chemotherapy are at risk for hospitalization. Predictors of unplanned hospitalization among older adults receiving chemotherapy for cancer were recently published using data from a study conducted by the Cancer and Aging Research Group (CARG). Our study aimed to externally validate these predictors in an independent cohort including older adults with advanced cancer receiving chemotherapy. Methods: This validation cohort included patients (n=369) from the GAP70+ trial usual care arm. Enrolled patients were aged ≥70 years with incurable cancer and were starting a new line of chemotherapy. Previously identified risk factors proposed by the CARG study were ≥3 comorbidities, albumin level <3.5 g/dL, creatinine clearance <60 mL/min, gastrointestinal cancer, ≥5 medications, requiring assistance with activities of daily activities (ADLs), and having someone available to take them to the doctor (ie, presence of social support). The primary outcome was unplanned hospitalization within 3 months of treatment initiation. Multivariable logistic regression was applied including the 7 identified risk factors. Discriminative ability of the fitted model was performed by calculating the area under the receiver operating characteristic (AUC) curve. Results: Mean age of the cohort was 77 years, 45% of patients were women, and 29% experienced unplanned hospitalization within the first 3 months of treatment. The proportions of hospitalized patients with 0–3, 4–5, and 6–7 identified risk factors were 24%, 28%, and 47%, respectively (P=.04). Impaired ADLs (odds ratio, 1.76; 95% CI, 1.04–2.99) and albumin level <3.5 g/dL (odds ratio, 2.23; 95% CI, 1.37–3.62) were significantly associated with increased odds of unplanned hospitalization. The AUC of the model, including the 7 identified risk factors, was 0.65 (95% CI, 0.59–0.71). Conclusions: The presence of a higher number of risk factors was associated with increased odds of unplanned hospitalization. This association was largely driven by impairment in ADLs and low albumin level. Validated predictors of unplanned hospitalization can help with counseling and shared decision-making with patients and their caregivers.

ClinicalTrials.gov identifier: NCT02054741

Submitted June 2, 2022; final revision received October 10, 2022; accepted for publication November 4, 2022.

Author contributions: Conception/Design: Mohamed, Loh, Mohile, Klepin. Collection and/or assembly of data: Mohamed, Mohile, Tylock. Data analysis and interpretation: Mohamed, Loh, Mohile, Sohn, Klepin. Manuscript—original draft: All authors. Manuscript—review & editing: All authors.

Disclosures: Dr. Loh has disclosed serving as a consultant for Pfizer and Seattle Genetics; and receiving honoraria from Pfizer Inc. The remaining authors have disclosed that they have not received any financial considerations 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 Division of Cancer Prevention, National Cancer Institute, of the National Institutes of Health under award number R01CA177592 (S.G. Mohile), and by the National Institute on Aging of the National Institutes of Health under award numbers K24AG056589 (K.P. Loh) and K76AG064394 (A. Magnuson).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Mostafa R. Mohamed, MBBCh, MSc, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY 14642. Email: mostafa_mohamed@urmc.rochester.edu

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