Predicting survival in cancer patients with and without 30‐day readmission of an unplanned hospitalization using a deficit accumulation approach

Abstract

BackgroundFor cancer patients with an unplanned hospitalization, estimating survival has been limited. We examined factors predicting survival and investigated the concept of using a deficit‐accumulation survival index (DASI) in this population.MethodsData were abstracted from medical records of 145 patients who had an unplanned 30‐day readmission between 01/01/16 and 09/30/16. Comparison data were obtained for patients who were admitted as close in time to the date of index admission of a study patient, but who did not experience a readmission within 30 days of their discharge date. Our survival analysis compared those readmitted within 30 days versus those who were not. Scores from 23 medical record elements used in our DASI system categorized patients into low‐, moderate‐, and high‐score groups.ResultsThirty‐day readmission was strongly associated with the survival (adjusted hazard ratio [HR] 2.39; 95% confidence interval [CI], 1.46‐3.92). Patients readmitted within 30 days of discharge from index admission had a median survival of 147 days (95% CI, 85‐207) versus patients not readmitted who had not reached median survival by the end of the study (P < .0001). DASI was useful in predicting the survival; median survival time was 78 days (95% CI, 61‐131) for the high score, 318 days (95% CI, 207‐426) for the moderate score, and not reached as of 426 days (95% CI, 251 to undetermined) for the low‐score DASI group (P < .0001).ConclusionsPatients readmitted within 30 days of an unplanned hospitalization are at higher risk of mortality than those not readmitted. A novel DASI developed from clinical documentation may help to predict survival in this population.

Holiday ratio of hospitalization and 30‐day readmission rates among cancer patients after major surgery

“…The survival rates were statistically significantly higher in those patients without 30‐day readmission after discharge than in those with 30‐day readmission in the subgroups with colon cancer and HNC. This result is similar to that found by Hembree et al 28 Patients readmitted within 30 days of an unplanned hospitalization are at higher risk of mortality than those not readmitted. This result underscores the importance of reducing the occurrence of 30‐day readmission, an event which is related to the patient's subsequent long‐term treatment outcomes.…”

Validating biologic age in selecting elderly patients with pancreatic cancer for surgical resection

“…A strength of our study is that the methodology utilized adhered to the mathematical modeling used in previously validated non‐PC DAFI studies, which provide additional support to the development of a DAFI 2,23–25 . An interesting finding in our study was the slightly higher PC frailty rates (61.2% overall population) compared to nonpancreas cancer frailty rates (49% gynecologic cancers, 53% multiple myeloma, and 53.7% solid tumors), which may reflect the debilitating effect of PC on biologic age, patient tolerance of aggressive treatment regimens, and differences in biologic age among different cancers 31–33 . Together, these findings suggest variability in the vulnerability of patients with cancer, supporting the need for cancer‐specific DAFIs to guide physicians in complex oncology management decisions 39 …”

“…The DAFI, compared with other measures of frailty, may better characterize a decline in function among elderly patients without cancer 9,25–28 . Furthermore, the DAFI has been found to predict treatment‐related toxicity, drug discontinuation, patient hospitalization, and mortality in certain cancers; thus, it has the potential to be used as a clinical screening tool in elderly patients with PC 29–33 …”

A simple test‐based frailty index to predict survival among cancer patients with an unplanned hospitalization: An observational cohort study

“…The FI included 53 health-related items, 20 of which represented the domains of clinical/laboratory tests, healthcare use, and objective cancer-specific items (such as presence or absence of metastatic disease) and were derived from a previously published cancer-specific TBFI (Table S1) called the deficit-accumulation survival index (DASI). 33 The remaining 33 items represented domains of activities of daily living (ADLs), instrumental ADLs, mobility and fall risks, cognition and memory, Eastern Cooperative Oncology Group (ECOG) performance status, comorbidities, and symptom management, and these items were collected through a selfreporting survey/questionnaire derived from elements of the comprehensive geriatric assessment (CGA) tool (Table S2). To calculate frailty scores, we divided the summed deficits by the total number of items measured, with the potential scores ranging from zero to one.…”