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.
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.
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 Status||Medial Survival (Days)|
|Line of Therapy||Median Survival (Days)|
|Dose of Therapy||Median Survival (Days)|
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
Legal entity responsible for the study
Oncology Department, Royal Free Hospital, London
All authors have declared no conflicts of interest.