Treatment patterns, acute-care utilization, and clinical outcomes among patients with lung cancer and sickle cell disease: A multicenter propensity score–matched real-world analysis.

Abstract

e20706 Background: Sickle cell disease (SCD) is associated with chronic organ dysfunction, heightened thrombo inflammatory risk, and frequent acute-care utilization. Individuals with SCD who develop lung cancer represent a clinically vulnerable and understudied population, with limited real-world evidence on treatment patterns and inpatient outcomes. We evaluated acute-care utilization and short-term clinical outcomes among individuals with lung cancer with and without coexisting SCD using a large multicenter electronic health record database. Methods: We conducted a retrospective cohort study using the TriNetX Analytics Network, a federated, multicenter platform that aggregates de-identified electronic health record data. Adult individuals with lung cancer were stratified by the presence or absence of SCD. To reduce confounding, individuals with lung cancer and SCD were propensity score–matched 1:1 to individuals without SCD using logistic regression incorporating demographics, baseline comorbidities, and socioeconomic risk factors. Nearest-neighbor matching without replacement was performed using a caliper width of 0.1 pooled standard deviations, with balance assessed using standardized mean differences. Primary outcomes included in-hospital mortality and intensive care unit (ICU) admission. Secondary outcomes included respiratory failure requiring intubation and venous thromboembolism. Results: After matching, 291 individuals with lung cancer and SCD were compared with 291 matched individuals without SCD, achieving excellent covariate balance (all standardized mean differences < 0.02). Prior to matching, individuals with SCD had a higher burden of chronic comorbidities, including chronic kidney disease, heart failure, cerebrovascular disease, liver disease, and chronic obstructive pulmonary disease. Following matching, in-hospital mortality was similar between individuals with and without SCD (24.7% vs 23.4%; effect estimate 1.07, 95% CI 0.77–1.49; p = 0.63). ICU admission rates did not differ (17.2% vs 15.5%; 1.14, 95% CI 0.76–1.70; p = 0.83), nor did respiratory failure requiring intubation (4.5% vs 5.2%; 0.89, 95% CI 0.42–1.88). Venous thromboembolism was numerically higher among individuals with SCD (15.5% vs 11.7%; 1.42, 95% CI 0.91–2.22), without statistical significance. Conclusions: Among hospitalized individuals with lung cancer, coexisting sickle cell disease was not associated with increased in-hospital mortality, ICU admission, or respiratory failure after propensity score matching, despite a substantially higher baseline comorbidity burden. A numerically higher rate of thromboembolic events suggests a potential area for targeted risk mitigation in this vulnerable population.