Impact of palliative chemotherapy in hospitalized patients with advanced solid tumors.

Abstract

11150 Background: The role of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (PS) remains uncertain since this population is underrepresented in clinical trials. Retrospective studies of patients with an Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) > 2 consistently demonstrate poorer survival and increased treatment-related toxicities. This study aimed to evaluate the clinical impact of PC in hospitalized patients and its association with PS and outcomes. Methods: This retrospective chart review was conducted between January 2018 and July 2024 across a five-hospital health system. The primary endpoint was overall survival (OS), defined as the time from the first dose of inpatient chemotherapy to death or last follow-up. Secondary outcomes included in-hospital mortality, length of stay, 30- and 60-day mortality, and toxicity. Continuous variables were compared using the Mann-Whitney U test or the two-sample t-test and categorical variables were compared using the Chi-squared or Fisher’s exact test. Time to event data were assessed using the Kaplan-Meier method. A p-value < 0.05 was considered statistically significant. Results: A total of 383 patients were included in this study. Of these, 227 patients had an ECOG-PS ≤ 2, and 156 patients had an ECOG-PS > 2. The median age was 60 years, and 57% were female. Common primary tumor sites included gastrointestinal, gynecologic, and lung. At presentation, 288 patients were chemotherapy-naïve, and 88% were hypoalbuminemic. The median OS was 188 days. Patients with an ECOG-PS ≤ 2 had a significantly longer median OS compared to those with an ECOG-PS > 2 (293 vs 77 days, p<0.0001). Mortality rates were higher in patients with ECOG-PS > 2 during the index hospitalization (17% vs 6%, p=0.0005), at 30 days (24% vs 14%, p=0.015), and at 60 days (36% vs 21%, p=0.001). Despite these differences, bleeding and infection rates were similar between groups. Median duration of hospitalization was 13 days, with significantly longer stays observed in patients with poor PS (16 vs 10 days, p<0.0001). Although toxicity rates were comparable overall, patients with ECOG-PS > 2 experienced significantly higher rates of thrombocytopenia (39% vs 25%, p=0.018) and neutropenia (40% vs 27%, p=0.028). In univariate analysis, significant predictors of shorter survival included ECOG-PS > 2 (p<0.0001), age > 60 (p=0.0097), Charlson Comorbidity Index ≥ 8 (p=0.02), hypercalcemia (p=0.0014), and hypoalbuminemia (p=0.0014). In multivariate analysis, all factors except age > 60 remained independent predictors of shorter survival. Conclusions: PC in hospitalized cancer patients with ECOG-PS > 2 was associated with shorter survival, longer hospital stays, and higher rates of early mortality. These findings emphasize the importance of careful patient selection and the need for further research to optimize care strategies in this population.