Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy

SIMPLE SUMMARY: Unplanned hospitalizations (UHs) are common among elderly patients with cancer who receive chemotherapy. This fact decreases quality of life or performance status and increases health costs. Our objective was to determine predictive factors for UH in this population. A score based on six variables taken from geriatric assessment and chemotherapy characteristics was developed in a series of 493 elderly patients receiving chemotherapy. The use of this score may reliably identify patients at risk for UH, thus helping to plan treatment, implement adaptive measures, and set up a close follow-up schedule. ABSTRACT: Purpose: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. Methods: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0–1: 17.5%; 2: 34%; and 3–7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67–0.77). Conclusion: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatment.