Factors Associated with In-hospital Mortality of Unplanned Hospital Admissions in Lung Cancer Patients with Palliative Care
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Abstract
ABSTRACT
Background: Lung cancer is the most common cancer worldwide and the leading cause of cancer death. The symptom burden that advanced lung cancer patients experience in the last months of their lives often leads them to unplanned hospital admissions (UHA). Advanced care planning (ACP) can reduce the provision of medical futility. However, the timing of initiating ACP can be challenging for physicians. This study aimed to examine the factors associated with in-hospital mortality of UHA in patients with palliative lung cancer that may be a guide for physicians to select the right patients and the right time for ACP.
Design Materials and Methods: This retrospective cohort analysis included unplanned hospitalized patients with palliative lung cancer from January 2017- to April 2022 at Chiang Rai Prachanukroh Hospital. Multivariable logistic regression was used to identify significant risk factors for in-hospital mortality.
Results: Five hundred and seventy-three UHAs were included for analysis, 125 (21.82%) were non-survived admissions. Four factors were identified as independent predictors for in-hospital mortality: pneumonia (aOR = 2.12, 95% CI 1.19-3.77, p = 0.011), sepsis (aOR = 3.83, 95% CI 1.56-9.43, p = 0.003), high-flow nasal cannula required (aOR = 4.34, 95% CI 1.05-18.02, p = 0.043), and endotracheal intubation (aOR = 4.41, 95% CI 1.65-11.82, p = 0.003) within first 48 hours of admission.
Conclusions: In Thailand, more than one fifth of patients with palliative lung cancer died in the hospital after UHA. Early initiation of ACP during hospitalization in patients with risk factors associated with in-hospital death may improve the quality of end-of-life (EOL) care and reduce medical futility
Keywords: lung cancer, palliative care, in-hospital mortality, unplanned hospital admission
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