Evaluation of factors predicting the benefit from systemic oncological treatment for severely ill hospitalized patients: a retrospective study

• Published in: BMC palliative care Vol. 22; no. 1; pp. 1 - 131
• Main Authors: Neves, Milena Brachmans Mascarenhas, Neves, Yuri Costa Sarno, Bomonetto, Juliana Vieira Biason, Matos, Priscila Prais Carneiro, Giglio, Auro Del, Cubero, Daniel de Iracema Gomes
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 06.09.2023; BioMed Central; BMC
• Subjects: Albumin; Analysis; Bilirubin; Cancer; Cancer therapies; Care and treatment; Chemotherapy; Creatinine; ECOG; Endocrine therapy; Hemoglobin; Hormone therapy; Hospital medicine; Hospital patients; Hospitalization; Hospitals; Leukocytes; Medical records; Metastasis; Multivariate analysis; Neutrophils; Oncology, Experimental; Palliative care; Palliative treatment; Patient outcomes; Patients; Patients with cancer; Prognosis; Proteins; Software; Statistical significance; Systemic oncological treatment; Brazil
• ISSN: 1472-684X; 1472-684X
• DOI: 10.1186/s12904-023-01256-8

Abstract Background Patients with cancer in the disease’s end-stage with poor performance represent a challenging clinical scenario, as they have high chance of a fatal outcome due to clinical conditions, oncological emergencies, and/or metastatic disease. This study examines the factors predicting the potential benefit of “urgent” chemotherapy during hospitalization in this setting, thus addressing a research gap. Methods This retrospective observational study was conducted in the largest cancer center in the outskirts of São Paulo. It identified factors predicting the benefit from antineoplastic treatment in severe in-hospital patients admitted during 2019–2020, considering post-chemotherapy survival time as the main dependent variable. Data were retrieved from medical records. All patients aged ≥ 18 years, with an ECOG-PS score ≥ 2, and undergoing non-elective systemic cancer treatment were included. Results This study evaluated 204 records, of which 89 were included in the final analysis. A statistically significant association with the worse outcome (death within 30 days of chemotherapy) was found with higher ECOG performance status; chemotherapy dose reduction; lower values of serum albumin, hemoglobin, and creatinine clearance; and higher values of leukocytes, neutrophils, direct bilirubin, urea, and C-reactive protein. In the multivariate analysis, only albumin remained statistically associated with the outcome (hazard ratio = 0.35; confidence interval: 0.14, 0.90; p = 0.034). Conclusions Serum albumin and other clinical and laboratory variables might be associated with early post-treatment deaths in patients with cancer. The study data might help guide the decision to administer systemic treatment in this scenario and manage critically ill patients. This study adds to our knowledge of the factors predicting the objective benefits from “heroic” or “urgent” chemotherapy for hospitalized and severely ill patients with cancer.