Risk Factors for Hospitalizations Among Older Adults with Gastrointestinal Cancers

Abstract

Background Older adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in older adults with GI cancers have been limited. This study sought to identify GA-based risk factors for chemotherapy toxicity–related hospitalization among older adults with GI cancers. Patients and Methods We performed a secondary post hoc subgroup analysis of two prospective studies used to develop and validate a GA-based chemotherapy toxicity score. The incidence of unplanned hospitalizations during the course of chemotherapy treatment was determined. Results This analysis included 199 patients aged ≥65 years with a diagnosis of GI cancer (85 colorectal, 51 gastric/esophageal, and 63 pancreatic/hepatobiliary). Sixty-five (32.7%) patients had ≥1 hospitalization. Univariate analysis identified sex (female), cardiac comorbidity, stage IV disease, low serum albumin, cancer type (gastric/esophageal), hearing deficits, and polypharmacy as risk factors for hospitalization. Multivariable analyses found that patients who had cardiac comorbidity (OR 2.48, 95% CI 1.13-5.42) were significantly more likely to be hospitalized. Conclusion Cardiac comorbidity may be a risk factor for hospitalization in older adults with GI cancers receiving chemotherapy. Further studies with larger sample sizes are warranted to examine the relationship between GA measures and hospitalization in this vulnerable population.

Falls prechemotherapy and toxicity‐related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial

“…This is consistent with findings from a recent study of patients age 70 years and older with incurable solid tumors or lymphoma and at least one impaired geriatric assessment domain, which showed that falls were associated with toxicity-related hospitalization. 13 However, the relationship between falls and hospitalization was not significant among older adults with gastrointestinal malignancy 25 and another heterogeneous cohort of older adults treated with chemotherapy. 24 Differences between these studies suggest that for each specific cancer type and related treatment, fall history may reflect different vulnerabilities that predispose older adults to toxicity-related hospitalization.…”

“…1,2,[20][21][22] Prior studies have been limited to claims-based retrospective data, 1,2,21,22 heterogeneous samples of older patients with different cancer types, stage, and treatment regimens, and inconsistent findings. [23][24][25][26] Hence, whether fall history can independently identify those at risk for toxicity-related hospitalization during neoadjuvant or adjuvant breast cancer chemotherapy remains unknown.…”

“…However, in older adults with early breast cancer, the association between falls and risk for toxicity‐related hospitalization during chemotherapy remains unclear 1,2,20–22 . Prior studies have been limited to claims‐based retrospective data, 1,2,21,22 heterogeneous samples of older patients with different cancer types, stage, and treatment regimens, and inconsistent findings 23–26 . Hence, whether fall history can independently identify those at risk for toxicity‐related hospitalization during neoadjuvant or adjuvant breast cancer chemotherapy remains unknown.…”

Bayesian Network Analysis for Prediction of Unplanned Hospital Readmissions of Cancer Patients with Breakthrough Cancer Pain and Complex Care Needs

“…Furthermore, a recent investigation found that other demographic and clinical conditions are significantly associated with increased odds of hospitalization. These factors include female gender, diagnosis of gastric/esophageal cancer, polypharmacy (≥5 daily medications), decreased hearing, and patient-reported cardiac comorbidity (history of heart disease), as well as low serum albumin (<3.5 g/dL) [ 9 ].…”