EVALUATION OF INPATIENT CHEMOTHERAPY AMONG PATIENTS WITH CANCER
Giulia Petrone^1^, **Nobel Chowdhury^1^**, Shivani Handa^2^, Justine Anderson^2^, Deukwoo Kwon^2^, Aarti Sonia Bhardwaj^2^, Priya Jain^2^, Cardinale B. Smith^2^, Natalie S Berger^1^
^1^Mount Sinai Morningside-West Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States; ^2^Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
To be presented at the American Society of Clinical Oncologists (ASCO) Annual Meeting that will be held virtually and in Chicago, Illinois, United States from June 3-7, 2022.
**BACKGROUND/INTRODUCTION:** Administration of inpatient chemotherapy (IC) is associated with more aggressive end of life care, reduced use of palliative care (PC) and decreased quality of life (QOL). This study aims to identify risk factors associated with overutilization of IC.
**METHODS:** We conducted a retrospective chart review of all admissions where IC was administered at an academic center between January 2016 and December 2017. Patients were stratified by solid tumors (ST) versus hematologic malignancies (HM) and urgency for IC was assessed. We evaluated other variables which can impact patient care such as length of stay (LOS), reason for admission and for IC. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect taking into account correlations from multiple admissions per patient. All tests were two-sided and statistical significance was considered when p<0 .05.
**RESULTS:** We analyzed 880 admissions (17% ST). HM pts required frequent direct admission for IC compared to ST. ST patients (p< 0.0001), patients > 65 years (p=0.004) and pts with KPS ≤50% (p<0.0001) were most likely admitted for cancer complications rather than for IC. LOS (> 7 days) was significantly longer in HM admissions (p=0.0001), among patients with stage 4 cancer (p=0.014) and KPS ≤50% (p=0.0001). ST (p=0.006) and patients with KPS ≤50% (p=0.0001) received IC for a non-urgent indication significantly more often than HM. In 20% of ST admissions, patients received IC because the admission coincided with a non-urgent planned cycle compared to 3% of HM. In the adjusted analysis, tumor type was the most important factor correlated with urgency of IC (OR 0.42, 95% CI: 0.25-0.72; p=0.001). ST patients (p=0.0001), older patients (p=0.004) and patients with KPS ≤50% (p=0.0001) were less likely to respond to chemotherapy. Only 15% of HM admissions and 46% of ST admissions had a PC consult. 60-day mortality was significantly higher in ST patients than HM (p=0.002).
**CONCLUSION:** Inpatient chemotherapy is associated with poorer outcomes for patients with advanced stage solid tumors, patients with poor functional status and patients admitted for acute indications. Additionally, solid tumors patients have a higher mortality after inpatient chemotherapy compared to hematologic malignancies. Utilization of inpatient chemotherapy should be standardized to account for different patient characteristics and to reduce the incidence of nonurgent administration. Based on this data, we created a standardized protocol to better assess the appropriateness of inpatient chemotherapy to improve patient care, QOL, and reduce chemotherapy and healthcare utilization at the end of life.

EVALUATION OF INPATIENT CHEMOTHERAPY AMONG PATIENTS WITH CANCER

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