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Poster display session

1344 - Initiation of Systemic Anti-Cancer Treatment in the Inpatient Setting in a Tertiary Hospital in London

Date

10 Sep 2017

Session

Poster display session

Presenters

James Lam

Citation

Annals of Oncology (2017) 28 (suppl_5): v511-v520. 10.1093/annonc/mdx385

Authors

J. Lam1, K. Ng2, T. Emms2, R. Gillmore2

Author affiliations

  • 1 Oncology Department, UCL School of Clinical Medicine, NW3 2QG - London/GB
  • 2 Medical Oncology, Royal Free Hospital, London, NW3 2QG - London/GB
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Resources

Abstract 1344

Background

The landscape of adult medical oncology care has shifted across the past three decades from the hospital to the outpatient setting, reflecting factors such as patient preference, technological advancements in the delivery of therapeutics, and cost-effectiveness. There are no recent guidelines to indicate when systemic treatment should be initiated as an inpatient. This clearly presents difficulties, particularly since inpatients are associated with a poorer performance status.

Methods

We retrospectively generated data of patients at the Royal Free Hospital commencing cycle 1 of chemotherapy as an inpatient, with a particular focus on 30-day mortality, overall survival, performance status recorded prior to initiation, treatment dose and line of therapy. Data was collected over a period of 24 months from January 2015 to December 2016.

Results

We identified 34 patients across a range of tumour types and with varying performance status who fulfilled our criteria The median age of patients treated was 54.5 years. Of these, the 76% (26/34) were administered full dose therapy, with 17.6% given a 25% dose reduction, and 5.8% given with a 50% dose reduction. Of the 34 cases, 76% (26/34) were first line therapy. The treatment intent in all cases was palliative, except one case where the intent was neoadjuvant. There was a positive correlation between performance status, full-dose therapy, and first line therapy with survival (Table 1). The outcomes of inpatients were significantly worse than outpatients. 7 of 34 in our cohort died with 30 days (20.5%), while only 38.3% of them were alive at 6 months. This is compared to the overall 30-day mortality rate of our department at 2.9%.Table:

1455P Correlation between PS, line of therapy and dose of therapy with survival (days)

Performance StatusMedial Survival (Days)
0200
1101.5
261
364
Line of TherapyMedian Survival (Days)
1st line107.5
2nd line68
3rd line12
Dose of TherapyMedian Survival (Days)
Full Dose110
80%46
75%24
50%38

Conclusions

1) Inpatients commenced on systemic treatment are associated with poorer overall survival compared with outpatients. 2) We would suggest adherence to the new ‘2016 UK CQUIN: Optimising Palliative Chemotherapy Decision Making’, which recommends peer discussion within the MDT when o chemotherapy is commenced or continued when PS is greater or equal to 2 o decisions regarding commencement of 2nd line treatment or beyond are required, when there is outright progression through the first cycle of chemotherapy.

Clinical trial identification

Not applicable

Legal entity responsible for the study

Oncology Department, Royal Free Hospital, London

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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