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Causes for hospitalizing patients at a university hospital cancer clinic.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: The number of beds in our ward was reduced from 68 in 2008-9 (A) to 36 in 2012-13 (B). The aim was to increase our capacity by treating more patients on an outpatient basis. To plan future organization of our clinic, we analyzed why patients were admitted to our ward in these periods. Methods: Patients were identified from our administrative system and data were collected from the medical records. Results: In period A, 4,154 patients had 15,372 consultations at our outpatient clinic and 1,418 patients had 2,423 hospital stays. Corresponding numbers in B were 5,273, 24,650, 1,218, and 1,996. We analyzed 995 admissions (39 %) / 498 pts (35 %) in period A; and 915 admissions (46 %) / 499 pts (41 %) in B. Mean no. of admissions per patient was similar (A: 1.71, B: 1.64; p=.4). Admissions per patient were 1: 57 %; 2: 20 %; 3+: 23 %. Mean length of hospital stays were A: 6.5 and B: 6.4 days; proportions of beds occupied were A: 83 % and B: 93 %. Emergency admissions increased from A: 25 % to B: 48 % (p<.001). Re-admissions within 30 days after discharge increased from A: 7 % to B: 15 %. Age, gender, marital status and Charlson Comorbidity Index were similar in both periods. Lymphomas (19 %), breast (12 %) and prostate (9 %) were the most common cancers admitted. More patients in A had metastatic disease (A: 72 %, B: 66 %; p=.04). Admissions for staging or planning therapy decreased from A: 30 % to B: 7 % (p<.001). 29 % was admitted for treatment in both periods (68 % chemo- and 28 % radiotherapy). Admissions due to poor performance status (PS) and severe symptoms increased from 325 (34 %) to 538 (60 %) (p<.001). The largest increases were for infections (A: 36 [4 %], B: 104 [10 %]; p<.001) and neutropenic fever (A: 40 [4 %], B: 67 [7 %]; p=.004). Mean PS at admission increased from 1.8 to 2.0 (p<.001). Conclusions: The number of patients admitted due to poor PS, severe symptoms and treatment-toxicity increased significantly – and more than the number of patients treated. There were no obvious differences in patient characteristics, suggesting that the reason might be that patients now in general receive more therapy than only a few years ago. With the expected development of new therapies and an increasing incidence of cancer, it seems that more resources are needed to provide sufficient supportive care.
Abstracts by Bjørn Henning Grønberg:
Reduction in tumor size after the first course of cisplatin/etoposide (PE) in limited disease small-cell lung cancer (LD SCLC).Meeting: 2015 ASCO Annual Meeting | Abstract No: e18553
Variation in health-related quality of life (HRQoL) during chemotherapy for advanced non-small cell lung cancer.Meeting: 2013 ASCO Annual Meeting | Abstract No: 9562