Impact of the COVID-19 pandemic on inpatient outcomes for cancer patients in the United States.

Abstract

e23293 Background: The COVID-19 pandemic significantly disrupted cancer care in the United States, yet few studies have comprehensively examined its impact on inpatient outcomes for cancer patients. Understanding how cancer patients were impacted will allow us to better allocate healthcare resources in future public health events. Methods: We conducted a retrospective analysis of clinical data from inpatients with a cancer diagnosis included in the NIS database. Descriptive statistics summarized demographic and clinical characteristics, while regression analyses evaluated continuous (e.g. length of stay, cost) and binary outcomes (e.g. mortality). Rate ratios for interventions were calculated using negative binomial regression. All analyses were stratified by the COVID-19 pandemic timeline and weighted to account for the stratified sampling design of the NIS database. Results: Cancer patient admissions declined 100,000 from 2019 to 2020 without recovery in 2021. In-hospital complications rose during the pandemic, with significant increases for thromboembolic events (28.5%, p < 0.001), infectious complications (13.9%, p < 0.001), and drug-induced hematologic complications (7.9%, p < 0.05). Patients with COVID-19 experienced more infectious (71.9% , p < 0.001) and thromboembolic events (68.1%, p < 0.001) than non-COVID patients. Amongst COVID+ patients, routine discharge decreased 16%, with a 10% rise in transfers and a 5% rise in mortality. Overall routine discharge dropped 4% during the pandemic while home healthcare utilization increased, and mortality rose. Demographically, the lowest income quartile had 13-27% (p < 0.05) greater odds of in-hospital death compared to the fourth income quartile during the study period. Self-paying patients had 67-98% greater odds of in-hospital death during the study period compared to Medicare patients. Conclusions: The pandemic resulted in substantial disruptions to hospital care for cancer patients. Less patients were admitted, and those who were admitted experienced greater complications and mortality, especially if uninsured or low income. These findings emphasize the need for resilient healthcare systems capable of responding to public health emergencies while maintaining essential services. Policy efforts aimed at reducing healthcare disparities and building equitable and efficient healthcare systems will be critical to improving patient outcomes and safeguarding public health.