Association of hospitalized metastatic cancers of the lip, oral cavity, and pharynx, with burden of illness, and cachexia.

Abstract

e18043 Background: Recent studies have suggested that cancers of the lip, oral cavity and pharynx (CLOP) patients face high clinical and financial challenges. Although significant efforts have been made in understanding the treatment and clinical outcomes of hospitalized metastatic CLOP patients, less is known about the financial burden and its variation across different groups. In this study, we examined the variations in total cost, mortality and length of stay (LOS) between CLOP and all metastatic cancers. Methods: We utilized the 2021 National Inpatient Sample database to examine metastatic CLOP patients and additionally examined the metastatic breast cancer patients. We used generalized linear models to evaluate the financial burden and clinical outcomes in hospitalized CLOP patients compared to all metastatic cancer patients, with an emphasis on breast cancer (BC) for comparison. Since the data was collected during COVID year 2021, we also examined the burden of COVID-19 in hospitalized patients. Results: Among the 965,274 metastatic cancer patients, there were 20,920 metastatic CLOP patients and 46,315 metastatic breast cancer (BC) patients. In the adjusted analysis, CLOP patients were associated with higher cost (Coeff: 1.34, 95%; CI: 1.28-1.42), higher LOS (Coeff: 1.22, 95%; CI: 1.13-1.32), lower in-hospital mortality (aOR: 0.83, 95%; CI: 0.73-0.95), higher weight loss (aOR: 2.16, 95%; CI: 1.20-2.33), and higher cachexia (aOR: 1.67, 95%; CI; 1.47-1.89). We also noted that CLOP patients compared to all metastatic cancers, were associated with alcohol dependence (aOR: 2.22, 95%; CI: 1.96-2.52) and hypertension (aOR1: 1.29, 95%; CI: 1.20-1.38). We do not see similar associations with the BC cohort, except for lower in-hospital mortality (aOR: 0.87, 95%; CI: 0.80-0.96). In the adjusted analysis, breast cancer patients had a lower associated cost (Coeff: 0.91, 95%; CI: 0.88-0.94) and lower LOS (Coeff: 0.90;95% CI: 0.85-0.95). Breast cancer compared to other metastatic cancer had higher obesity (aOR:1.23, 95%; CI: 1.15-1.31). Compared to other metastatic cancers, the CLOP patients had lower COVID infections, septicemia, and infectious complications (ICs) (p < 0.001). However, the association between BC patients and other complications was not statistically significant. Conclusions: The findings of this study reveal a significant association between CLOP and an increased financial burden when compared to other metastatic cancers despite having low ICs. In addition, this is the first time it is reported that compared to other metastatic cancer cohort, CLOP are associated with higher cachexia and clinical complications. These results point to the critical need for investigating the underlying factors contributing to both the elevated costs and the increased risk of cachexia to develop targeted strategies for this patient population.