Evaluating three-month survival benefit of inpatient chemotherapy in a safety-net hospital.

Abstract

e13534 Background: Safety-net hospitals treat underprivileged and vulnerable population, most of whom are uninsured/underinsured. This often poses barriers to acceptance at many hospitals. Additionally, pts frequently present with more advanced diseases here (Farkas, JCO 2012). Systemic treatment is mostly administered on an ambulatory basis because of effective supportive care, clear financial incentives; the association of good performance status (PS) with better outcomes, and patient preference (Mor, J Clin Epid 1988). Methods: We reviewed patterns of inpatient chemotherapy (IPC) administration to determine efficacy and outcomes over a 5-year period at a safety-net hospital, examining malignancy type, reason for IPC treatment, treatment regimen (typically outpatient or inpatient), and three-month survival. Results: 196 pts received IPC between Jan 2018 to Dec 2023, 163 of whom had active cancers. Out of 163, twenty-five received chemotherapy regimens that could only be administered inpatient. 52% pts received at least one cycle of chemotherapy after discharge. 79% of the 81 pts with hematologic malignancies and 52% of the 82 pts with solid malignancies were alive at three months. The reasons for IPC were rapid disease progression, worsening symptoms, or declining PS in 75% and social constraints in 11% cases. Death occurred in 11% of pts on the same hospitalization as the IPC, 13% were either lost to follow up or discharged to hospice. Outcomes noted to be grave for pts with KICS/Kaposi sarcoma. 6 pts with KS were treated with liposomal doxorubicin in the ICU. One left AMA after extubating and is presumed dead, two died within a month of inpatient treatment and the remaining three did not survive three months. At least two patients with gyn malignancies completed six cycles of chemotherapy during the same hospitalization due to disposition issues. Individuals receiving IPC due to poor social support frequently required readmission, had poor outpatient follow-up, or died shortly thereafter. Three-month survival was more favorable in pts with multiple myeloma or those admitted for drug-desensitization. Conclusions: Survival outcomes were poor for pts who received typical outpatient regimens on an inpatient basis whether due to declining PS/worsening symptoms or social constraints. IPC is undesired by pts, costly and is often not good use of resources. Pts with highly responsive cancers with fair-to-good PS had acceptable outcomes. Earlier discussion of hospice and goals should not be replaced by chemotherapy. Institutional unavailability of key oral agents, staffing limitations and limited outpatient resources often contribute to IPC. Better access to modern agents, enhanced social support and outpatient resources, as well as better decision making improve cancer care. Our results do not support IPC as a frequent approach to cancer care in safety-net hospitals, especially in patients with solid cancers.