Causes for hospitalizing patients at a university hospital cancer clinic.

Health Services Research
Session Type and Session Title: 
This abstract will not be presented at the 2014 ASCO Annual Meeting but has been published in conjunction with the meeting.
Abstract Number: 
J Clin Oncol 32, 2014 (suppl; abstr e17515)
Bjørn Henning Grønberg, Marte Bjorkvoll, Cecilie Lund Mathisen, Jo-Asmund Lund, Stein Kaasa; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital – Trondheim University Hospital, Trondheim, Norway

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Abstract Disclosures


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.