Inpatient chemotherapy in lung cancer: Survival outcomes in small cell and non–small cell lung cancer.

Abstract

e20592 Background: Patients who receive initial chemotherapy in the palliative setting while inpatient generally have a poor performance status or high disease burden. However, when patients are diagnosed with a highly chemo-responsive cancer such as small cell lung cancer (SCLC) initiation of inpatient chemotherapy is advised. The outcomes in non-small cell lung cancer (NSCLC) are less understood. To our knowledge, this is the first large-scale study to specifically address overall survival (OS) when initiated first line treatment inpatient vs outpatient for both SCLC and NSCLC. Methods: A retrospective cohort study using the TriNetX Research Network, a federated platform of HIPAA-compliant patient records from 159 healthcare organizations (HCO) from the Global Collaborative Network was carried out. Treatment for SCLC and NSCLC was determined based on NCCN guidelines, immunotherapy was only included for outpatient, assuming it was not administered in the inpatient. Each group was balanced for age at diagnosis and male sex. Kaplan-Meier survival curves were used to assess OS. Results: SCLC Of 4,484 SCLC patients from 36 HCOs (627 inpatient, 3,857 outpatient), 620 patients were identified for each cohort after balancing. OS did not differ for SCLC patients receiving first-line treatment inpatient vs outpatient. At 6-, 12- and 24- months the survival probability of inpatient initiation vs outpatient was noted to be 75% vs 73%, 51% vs 53% and 31% vs 31%, respectively. Patients who started treatment in the outpatient were noted to have less subsequent ED visits (OR 0.264, CI 0.212-0.328) and less hospital admissions (OR 0.167, CI 0.133-0.209). NSCLC: Of 65,375 NSCLC patients (8,704 inpatient/58,066 outpatient) across 35 HCOs, 7,308 per cohort remained after balancing Worse OS was noted in those patients with NSCLC who received their first line treatment inpatient. The survival probability of outpatient was superior at 6, 12 and 24 months with 84%, 72% and 59% (compared to inpatient with 83%, 69% and 54%, respectively). Patients who started treatment in the outpatient were noted to have less ED visits (OR 0.264, CI 0.247-0.282) and less hospital admissions (OR 0.085, CI 0.079-0.092). Conclusions: Analysis reveals no survival difference for SCLC patients initiated on treatment as inpatients vs outpatients, confirming that hospitalization for poor performance status shouldn’t contraindicate palliative chemotherapy in SCLC. Conversely, NSCLC patients initiated as inpatients experienced worse OS. Inpatient treatment for these patients requires careful consideration as the absolute difference in OS was relatively small but there is an increase in healthcare utilization. The appropriateness of inpatient chemotherapy for NSCLC should be evaluated carefully and included in the consideration of goals of care discussion, adjusted treatment regimens, and timely referral to hospice care.