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Characteristics and outcome of unplanned hospital admissions in patients with lung cancer: a longitudinal tertiary center study. Towards a strategy to reduce the burden

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Abstract

Background

Unplanned hospital admissions (UHAs) are frequent in lung cancer, but literature on this topic is scarce. The aim of this study is to gain insight in the demographics, patterns of referral, causes, presenting symptoms, and final outcome of these UHAs. A strategy to improve quality of care and reduce the number and cost of UHAs was suggested based upon these findings.

Patients and methods

In retrospective analysis of all consecutive UHAs in a 6-month period in a tertiary center, demographics, pattern of referral, clinical data, tumor control status, final diagnosis, duration of hospitalization, and outcome were examined.

Results

Two hundred seven UHAs were recorded. Male/female ratio was 185/62, mean age 65.5 years, performance status (PS) on admission 0–1 in 32 %, 2 in 37.2 %, and 3–4 in 30.8 % of patients. Patient referral occurred by general practitioner in 33.6 % or specialist in 25.5 % and in 40.9 % on own initiative. UHAs were therapy-related in 23.9 %, cancer-related in 47.4 %, comorbidity-related in 19.4 %, or of unclear nature in 9.3 %. Most frequent causes were infections (21.9 %) and respiratory problems (17.0 %). Mean length of stay was 9.5 days. Final outcome was 10.1 % mortality, 6.9 % hospice care transfers, and 79.4 % home returns (including 18.2 % same day returns).

Conclusion

UHAs in lung cancer were more cancer- than therapy-related. Majority of patients (2/3) were not seen by their general practitioner. A significant number of same day returns were noted. UHAs in patients with poor PS, uncontrolled cancer and cancer-related events had the worst outcome. This work is a first step in identifying specific characteristics of UHAs in lung cancer patients, which may lead to strategies to reduce the burden of UHAs.

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    Authors and Affiliations

    1. Department of Pulmonology, Respiratory Oncology Unit, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium

      Kristof Cuppens, Christel Oyen, Aurélie Derweduwen, Anouck Ottevaere & Johan Vansteenkiste

    2. Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium

      Walter Sermeus

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    1. Kristof Cuppens
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    Correspondence to Johan Vansteenkiste.

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    Kristof Cuppens and Christel Oyen contributed equally to this work.

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    Supplementary Table S1

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    Supplementary Figure S1

    Distribution (in %) according to referral pattern by general practitioner (GP-REF), patient self-referral (SELF-REF) or by specialist (SPEC-REF) of unplanned hospital admissions according to the final main diagnosis. (JPG 95 kb)

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    Cuppens, K., Oyen, C., Derweduwen, A. et al. Characteristics and outcome of unplanned hospital admissions in patients with lung cancer: a longitudinal tertiary center study. Towards a strategy to reduce the burden. Support Care Cancer 24, 2827–2835 (2016). https://doi.org/10.1007/s00520-016-3087-4

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    • DOI: https://doi.org/10.1007/s00520-016-3087-4

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