Zachary R Moore1, Nhat-Long Pham1, Jennifer Lobo Shah1, Lucien Nedzi1, Baran D Sumer2, Andrew T Day2, Saad A Khan3, David J Sher4. 1. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 2. Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 3. Department of Medical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 4. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: David.Sher@utsouthwestern.edu.
Abstract
CONTEXT: Radiotherapy is highly effective for treating squamous cell carcinoma of the head and neck but is often associated with significant toxicities and severe morbidity. Unplanned emergency department (ED) visits and hospitalizations are common during treatment and come with a substantial financial and health burden as well as the potential for impaired long-term outcomes due to treatment disruption. OBJECTIVES: The objective of this study was to identify patient, disease, and treatment characteristics that were associated with ED encounters and admissions. METHODS: A cohort of 462 patients with cancer of the head and neck treated with radiotherapy at UT Southwestern between 2010 and 2015 was retrospectively analyzed. The risks of ED visits, admissions, multiple admissions, and extended admissions were determined. Risk factors for an unplanned hospital encounter were analyzed using univariate and multivariate logistic regression. RESULTS: Overall, 36% of patients had an unplanned hospital encounter during the treatment window. Patients with advanced disease, those with high comorbidity score, and those treated with concurrent chemotherapy were more likely to have unplanned admissions/ED visits. Social factors such as marital status, smoking status, and registration in the public hospital system were also strongly associated with admissions and multiple encounters. CONCLUSION: The high rate of admissions and ED visits emphasizes the importance of anticipating and managing toxicities during treatment. Social factors have a strong association with unplanned encounters and may present opportunities for targeted interventions to reduce admissions for patients at highest risk.
CONTEXT: Radiotherapy is highly effective for treating squamous cell carcinoma of the head and neck but is often associated with significant toxicities and severe morbidity. Unplanned emergency department (ED) visits and hospitalizations are common during treatment and come with a substantial financial and health burden as well as the potential for impaired long-term outcomes due to treatment disruption. OBJECTIVES: The objective of this study was to identify patient, disease, and treatment characteristics that were associated with ED encounters and admissions. METHODS: A cohort of 462 patients with cancer of the head and neck treated with radiotherapy at UT Southwestern between 2010 and 2015 was retrospectively analyzed. The risks of ED visits, admissions, multiple admissions, and extended admissions were determined. Risk factors for an unplanned hospital encounter were analyzed using univariate and multivariate logistic regression. RESULTS: Overall, 36% of patients had an unplanned hospital encounter during the treatment window. Patients with advanced disease, those with high comorbidity score, and those treated with concurrent chemotherapy were more likely to have unplanned admissions/ED visits. Social factors such as marital status, smoking status, and registration in the public hospital system were also strongly associated with admissions and multiple encounters. CONCLUSION: The high rate of admissions and ED visits emphasizes the importance of anticipating and managing toxicities during treatment. Social factors have a strong association with unplanned encounters and may present opportunities for targeted interventions to reduce admissions for patients at highest risk.
Authors: Hye Ri Han; Gregory M Hermann; Sung Jun Ma; Austin J Iovoli; Kimberly E Wooten; Hassan Arshad; Vishal Gupta; Ryan P McSpadden; Moni A Kuriakose; Michael R Markiewicz; Jon M Chan; Mary E Platek; Andrew D Ray; Fangyi Gu; Wesley L Hicks; Elizabeth A Repasky; Anurag K Singh Journal: Oral Oncol Date: 2020-06-16 Impact factor: 5.337
Authors: David J Sher; Sepeadeh Radpour; Jennifer L Shah; Nhat-Long Pham; Steve Jiang; Dat Vo; Baran D Sumer; Andrew T Day Journal: JCO Clin Cancer Inform Date: 2022-03