Early inpatient chemotherapy in central nervous system (CNS) tumors: Predictors, treatment patterns, and in-hospital outcomes.

Abstract

e14035 Background: Timely inpatient chemotherapy may alter the trajectory of acute CNS tumor hospitalizations by controlling disease burden before critical complications develop. We evaluated demographic, clinical, and hospital factors associated with receipt of chemotherapy within the first hospital day (Day 0–1) and examined whether early administration improves in-hospital outcomes. Methods: Using the Nationwide Inpatient Sample, we identified 332,100 CNS tumor hospitalizations from 2016–2020. Patients were stratified by chemotherapy given within Day 0–1 versus after Day 1. Categorical outcomes were compared with Pearson chi square tests and continuous variables with Welch’s t-tests. Multivariable logistic regression identified independent predictors of early chemotherapy, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Only 4.5% received early chemotherapy. They were markedly younger (11.6 ± 13.6 vs 52.5 ± 22.4 years, p<0.001) and had lower comorbidity burden (CCI 3.14 ± 2.26 vs 4.87 ± 2.57, p<0.001), early treated patients experienced dramatically better outcomes across nearly every major complication. Mortality was lower (0.2% vs 3.6%, p<0.001), as were rates of mechanical ventilation (0.4% vs 5.5%), vasopressor use (0.1% vs 0.8%), acute kidney injury (1.5% vs 6.5%), sepsis (0.9% vs 5.6%), hemorrhage (0.8% vs 9.6%), organ failure (2.9% vs 24.7%), venous thromboembolism (0.5% vs 6.7%), major adverse cardiac events (0.3% vs 7.6%), cerebral edema (2.2% vs 39.9%), seizures (4.8% vs 25.3%), brain herniation (3.1% vs 13.1%), and Do-Not-Resuscitate orders (0.7% vs 14.1%) (all p<0.001). Early chemotherapy was also linked to shorter stays (4.77 ± 6.85 vs 6.94 ± 9.54 days) and lower total charges ($65,599 ± 137,225 vs $102,763 ± 146,139, p<0.001). Logistic regression confirmed that early chemotherapy independently predicted lower odds of death (aOR 0.55, 95% CI 0.37–0.81), organ failure (0.33, 0.28–0.39), sepsis (0.27, 0.22–0.33) and MACE (0.63, 0.46–0.85) even after adjusting for age, comorbidity, and hospital factors. Notably, transfusion (10.6% vs 3.0%, p<0.001) and frailty/malnutrition (13.7% vs 6.3%, p<0.001) were more frequent in early chemotherapy, indicating higher tumor burden and treatment intensity. Conclusions: Early inpatient chemotherapy for CNS tumors is strongly associated with markedly lower in-hospital mortality and critical complications despite higher indicators of disease acuity. These findings underscore the potential protective effect of initiating chemotherapy on the day of admission and support efforts to streamline early treatment pathways for hospitalized CNS tumor patients.