Impact of performance status on outcomes for solid tumor patients receiving inpatient chemotherapy.

Abstract

e23079 Background: Inpatient chemotherapy (IC) administration is often associated with high mortality, aggressive end of life care, and high healthcare costs. The use of IC in solid tumors varies across institutions, and guidelines are not clear. In this study, we evaluated patient characteristics including performance status (PS), tumor type, stage, and lines of therapy on the overall survival (OS) among solid tumor patients receiving IC to identify opportunities for enhanced chemotherapy stewardship. Methods: We retrospectively reviewed patients (age > 18 years) with a solid tumor malignancy who received IC while admitted to our medical center between March 2022 and March 2024. Patients were excluded if they were lost to follow up (LTFU) with fewer than 90 days of follow up from initial receipt of chemotherapy. Patients were evaluated for ECOG PS, stage, and line of treatment. Statistical tests were completed by utilizing the Mann-Whitney U Test. Results: A total of 260 patients were identified with 17 patients LTFU, leaving 243 for evaluation. Gastrointestinal (GI) tumors were the most common cancer type (n = 119), followed by lung cancer (n = 46), breast cancer (n = 20) and gynecologic cancers (n = 18; Table 1). The median OS was 4.7 months across all tumor types after initial receipt of IC. Among ECOG PS 0-2, OS was statistically greater compared to those with PS 3 (6.6 months vs 2.1 mo, p < 0.005), PS 4 (6.6 mo vs 1.1 mo, p < 0.005), and those with missing scores (6.6 mo vs 3.4 mo, p< 0.005). Those with metastatic disease at time of chemotherapy administration had shorter survival than those without metastatic disease (9.4 mo vs 4.3 mo, p = 0.03). Survival differences by treatment line among patients were not statistically significant. With GI cancers as the reference group, survival was statistically worse compared to those with gynecologic cancers, with median OS of 4.3 months versus 11.2 months. No statistically significant survival differences were observed among other cancer subtypes. Conclusions: Patients with advanced solid tumor malignancies receiving IC with ECOG PS 3-4 had significantly worse OS regardless of tumor subtype or line of therapy. This highlights the importance of accurate performance status evaluation when determining candidacy for IC and emphasizes the need for standardized protocols to enhance chemotherapy stewardship and optimize patient outcomes. Median OS and interquartile range (IQR) for survival from time of inpatient chemotherapy by cancer subtype. Cancer Type Median OS (IQR) Overall (n=243) 4.7 (1,1, 11.3) Gastrointestinal (n=119) 4.3 (1.4, 10.0) Genitourinary (n=19) 7.6 (2.5, 18.6) Lung (n=46) 3.1 (0.7, 14.3) Head and Neck (n=15) 3.1 (2.2, 9.7) Breast (n=20) 7.9 (1.6, 11.9) Gynecologic (n=18) 11.2 (8.1, 13.4) Sarcoma (n=8) 3.2 (2.2, 7.6) Others 1 (n=15) 1.1 (0.6, 2.4) 1 CNS, melanoma, thyroid cancer, mesothelioma, carcinoma of unknown primary, and neuroendocrine tumor of unknown primary site.