Demographic and clinical factors associated with care outcomes in hospitalized patients with cancer.

Abstract

e23112 Background: Patients with cancer often require hospital-level care to address symptoms and side effects, yet a dearth of research has sought to identify demographic and clinical factors associated with care outcomes in this population. Methods: We conducted a cohort study including adult patients with cancer admitted to the University of Oklahoma Medical Center from 1/2017-12/2022. We extracted patients’ demographics (i.e., age, sex, race) and clinical factors (i.e., comorbidities [Charlson Comorbidity Index {CCI}], cancer type) via the electronic health record. We used multivariable Cox regression models to explore associations of patients’ demographic and clinical factors with their care outcomes (i.e., hospital length of stay [LOS; hazard ratio {HR} for time to discharge], time to readmission, and overall survival [OS]). Results: We identified 20,683 hospitalized patients with cancer during our study period (mean age 62.2 ± 15.4, 51.5% female sex, 41.0% CCI 3+), with race categories of 80.1% White, 9.8% Black, 4.8% Native American, and 2.6% Asian. The most common cancer types were gastrointestinal (GI; 19.3%), genitourinary (GU; 13.8%), gynecologic (Gyn; 13.7%), lung (11.0%), and hematologic (10.8%). Median LOS was 4.0 days, with 30- and 90-day readmission rates of 15.3% and 22.9%, and median OS of 5.0 years. For LOS, CCI 3+ (HR = 0.68, p < .001) and hematologic cancer (HR = 0.55, p < .001) were associated with longer LOS; female sex (HR = 1.07, p < .001), melanoma (HR = 1.39, p < .001), GU (HR = 1.35, p < .001), Gyn (HR = 1.24, p < .001), and breast (HR = 1.16, p < .001) cancers (GI reference group) were associated with shorter LOS. For time to readmission , CCI 3+ (HR = 2.87, p < .001) and hematologic cancer (HR = 1.19, p < .001) were associated with shorter readmission time; older age (HR = 0.99, p < .001), Gyn (HR = 0.85, p < .001), head and neck (HR = 0.81, p < .001), GU (HR = 0.77, p < .001), breast (HR = 0.77, p < .001), and melanoma (HR = 0.63, p < .001) cancers were associated with longer time to readmission. For OS, older age (HR = 1.02, p < .001) and CCI 3+ (HR = 1.55, p < .001) were associated with shorter survival; female sex (HR = 0.94, p = 0.015), Asian race (HR = 0.81, p < .001), neuroendocrine (HR = 0.42, p < .001), GU (HR = 0.46, p < .001), head and neck (HR = 0.60, p < .001), sarcoma (HR = 0.61, p < .001), Gyn (HR = 0.67, p < .001), and breast (HR = 0.69, p < .001) cancers (GI reference group) were associated with longer survival. Conclusions: In this large cohort of hospitalized patients with cancer, we identified associations of patients’ demographic and clinical factors with several important care outcomes. Specifically, we found differences in hospital LOS, time to readmission, and OS based on age, sex, race, CCI, and cancer type. By identifying these factors associated with care outcomes among hospitalized patients with cancer, findings from this work can help inform targeted efforts to enhance care delivery and outcomes in this population.