Unplanned hospitalizations in older patients with cancer: Occurrence and predictive factors

Abstract

Background: This study aims to investigate the occurrence of unplanned hospitalizations in older patients with cancer and to determine predictive factors. Methods: A prospective Belgian multicentre (n = 22), observational cohort study was performed. Patients ≥70 years with a malignant tumor were included. Patients underwent G8 screening followed by geriatric assessment (GA) if abnormal at baseline and were followed for unplanned hospitalizations at approximately three months. Uni-and multivariable regression models were performed to determine predictive factors associated with unplanned hospitalizations in older patients with an abnormal G8. Results: In total, 7763 patients were included in the current analysis of which 2409 (31%) patients with a normal G8 score and 5354 (69%) with an abnormal G8 score. Patients with an abnormal G8 were hospitalized more frequently than patients with a normal G8 (22.9% versus 12.4%; p < 0.0001). Reasons for unplanned hospitalizations were most frequently cancer related (25.7%) or cancer therapy related (28%). In multivariable analysis, predictive factors for unplanned hospitalizations in older patients with cancer and an abnormal G8 were female gender, absence of surgery, chemotherapy, ADL dependency, malnutrition and presence of comorbidities. Conclusion: Older patients with cancer and an abnormal G8 screening present a higher risk (23%) for unplanned hospitalizations. Predictive factors for these patients were identified and include not only patient and treatment related factors but also GA related factors.

Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy

“…Of note, 87% of patients had an ECOG performance status ≤1. This is higher than that reported in other studies [10] and could have biased the results. The good condition in our patients derives from the fact that only those amenable for chemotherapy were included, whereas other studies also included patients receiving just supportive care [10].…”

“…The role of age is controversial. We and others [10] did not find a direct correlation, although two studies performed in the community population and in patients with colon cancer, found a correlation of UH with advanced age [17,21]. Finally, one study reported less risk of UH in the elderly, probably due to the use of less-aggressive treatment [8].…”

“…UH in the elderly can be the result of toxicity, worsening of cancer symptoms or worsening of comorbidities as a consequence of cancer or its treatment. A recent study including 8451 cancer patients aged ≥70 reported an incidence of UH of 20% in the next three months following the initiation of therapy [ 10 ].…”

“…Some studies have assessed the value of the geriatric assessment (GA) or its components to predict UH, with conflicting results. One study could not correlate GA with the risk of UH [ 12 ], whereas others have identified some related factors, such as dependency in instrumental activities of daily living (IADL) or in activities of daily living (ADL), malnutrition, presence of comorbidities, abnormal G8 [ 10 ], or reduced gait speed [ 13 ].…”

“…Previous studies in this setting included older patients receiving either chemotherapy or just palliative supportive care [ 7 , 10 ] or were focused on hematologic malignancies [ 13 ]. The identification of factors predicting UH in the older patients receiving chemotherapy could be used to set up adaptive or aggressive supportive measures around the time of chemotherapy initiation to prevent UH.…”