The burden of hyponatremia and hypercalcemia on hospitalizations and mortality in lung cancer patients in the United States: An analysis of nationwide inpatient database.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18256-e18256 ◽  
Author(s):  
Sukriti Kamboj ◽  
Varun Kumar ◽  
Stephen Mazurkivich ◽  
Warren Acker
Keyword(s):  
Lung Cancer ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Tobacco Consumption ◽  
The United States ◽  
Relative Increase ◽  
Cost Of Care ◽  
Lung Cancer Patients ◽  
Hospital Stays ◽  
Relative Decline

e18256 Background: In 2018, there were over 234,030 patients diagnosed with lung cancer in the US with over 154,050 deaths. While the incidence continues to fall (mostly due to reduced tobacco consumption ), the mortality continues to be high with an overall median five year survival rate of only 19%. It is important to identify factors which are associated with worse outcomes in these patients. We aim to note the trends in patients hospitalized with lung cancer who have hyponatremia and hypercalcemia. Methods: We used the Nationwide Inpatient Sample (2002-2013) to identify lung cancer hospitalizations with hyponatremia and hypercalcemia. We analyzed trends in incidence, in-hospital mortality, length of stay (LOS) and cost. We calculated adjusted odds ratios (aOR) for outcomes including in-hospital mortality. Results: A total of 1,404,228 patients were studied with lung cancer were hospitalized from 2005-2014. A number of admissions has been progressively declining from 159,568 in 2005 to 123,305 in 2014 with a relative decline of 21.8%. The overall incidence of hyponatremia in these patients was 8.62%, and it has been trending up from 6.79% to 10.48% (p < 0.001) from 2005-2014 with a relative increase of 57%. Hypercalcemia was reported in 2.59 % of patients admitted with lung cancer. The number of hospitalizations in lung cancer patients with hypercalcemia has increased from 2.19% to 3.17% (p < 0.001) with a relative increase of 49.3%. Hospitalizations for hyponatremia and hypercalcemia were more frequent in age 50-64 years, males and smokers. Lung cancer patients with hyponatremia have in-hospital mortality of 12.9 % (OR 1.43, p < 0.001). Patients who have hypercalcemia have in hospital mortality of 17.1%( OR 1.15, p < 0.001). Conclusions: This study studies trends in hospitalizations in patient with lung cancer and incidence of hyponatremia and hypercalcemia. It is noted that hyponatremia and hypercalcemia are associated with increase the risk of in hospital mortality and increase cost of care in lung cancer patients. Utilization of these findings in guiding management may lead to decreased hospitalizations, hospital stays, and improve outcomes for these patients.

PCN119 - SECONDARY CARE RESOURCE UTILIZATION AND COST OF CARE AMONG FINNISH NON-SMALL CELL LUNG CANCER PATIENTS

2018 ◽  
Vol 21 ◽  
pp. S34
Author(s):  
H. Loponen ◽  
V. Vihervaara ◽  
S. Ylä-Viteli ◽  
S. Torvinen ◽  
K. Tamminen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cancer Patients ◽  
Resource Utilization ◽  
Cell Lung Cancer ◽  
Secondary Care ◽  
Small Cell ◽  
Cost Of Care ◽  
Small Cell Lung ◽  
Lung Cancer Patients

scholarly journals Higher Mortality Rates in Breast and Lung Cancer Patients Admitted for Febrile Neutropenia: An Analysis of Outcomes Based on Data from the Nationwide Inpatient Sample from 2006-2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5904-5904
Author(s):  
Ankit Shah ◽  
Stuthi Perimbeti ◽  
Sumera Bukhari ◽  
Michael Wismer ◽  
Jordan Senchak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Mortality Rates ◽  
Primary Diagnosis ◽  
Lung Cancer Patients ◽  
Total Charges

Abstract Background: Febrile neutropenia is associated with significant morbidity, mortality, healthcare resource utilization and associated cost. However, data regarding the relationship of specific cancers with admission for febrile neutropenia and their outcomes is lacking. Methods: Using the ICD-9 codes 288.00 and 288.04, we identified all adult admissions with primary diagnosis of febrile neutropenia during the interval of 2006-2013 from the Nationwide Inpatient Sample (NIS). Hospitalization information regarding mortality rates, length of stay and total charges was extracted for each year. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Differences in these variables in teaching and nonteaching institutions were evaluated. ICD-9 codes for esophageal, colon, rectal, liver, pancreatic, bladder, prostate, cervical, renal, thyroid, lung, and melanoma skin cancers were selected and the percentage of admissions attributed to each malignancy was determined. Results: We identified 48,253 admissions (weighted N = 233,116) with a primary diagnosis of febrile neutropenia from 2006-2013. Most of these admissions occurred at teaching institutions (n=28,902, weighted n=139,574). In-hospital mortality rates for febrile neutropenia had a downward trend over the time period of 2006-2013 although the difference was not statistically significant (p=.082). Specifically, the in-hospital mortality rate was 2.73% in 2006 and 1.35% in 2013. Mean length of stay (days) has decreased from 5.67 (±.16) in 2006 to 5.32 (±0.06) in 2013 (p=.0001) while total charges have increased from $29,113 (±1089) in 2006 to $41,713 (±726) in 2013 (p=.0001). This is greater than the expected inflationary change from $29,133 to $33,641 over the same time period. Mean length of stay (days) was found to be higher at teaching (5.89±.03) than at non-teaching (5.25±.04) hospitals (p=.0001). Similarly, mean total charges were higher in teaching ($41,577±364) than in non-teaching ($34,176±345) institutions (p=.0001). When comparing teaching vs. non-teaching institutions, in-hospital mortality was not found to have a statistically significant difference (p=.2688). Of the 13 malignancies queried, lung cancer (11.06%) and breast cancer (8.40%) accounted for more admissions for febrile neutropenia than the other malignancies selected. Breast cancer (3.62%, p=.0001) and lung cancer (16.11%, p=.0001) were also associated with much higher in-hospital mortality rates compared with the other malignancies selected. Conclusions: Breast and lung cancer account for a significant number of admissions for febrile neutropenia, which is consistent with their national prevalence. Of particular note,breast and lung cancer patients who were admitted for febrile neutropenia had a higher risk of mortality. In lung cancer, the frequently associated smoking-related comorbidities may be contributing to this finding. While in breast cancer, patients with advanced disease have an increase in cumulative lifetime dose of chemotherapy due to prolonged survival and this may result in a weakened bone marrow, a more susceptible patient, and consequently an increase in febrile neutropenia and mortality rates. Thus, given the greater mortality rate and significant number of patients affected, patients with these two malignancies should receive special attention to ensure they receive prophylaxis with granulocyte stimulating agents and/or antibiotics after treatment with cytotoxic chemotherapy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Effects of a Multidisciplinary Care Conference on the Quality and Cost of Care for Lung Cancer Patients

2015 ◽  
Vol 100 (5) ◽  
pp. 1834-1838 ◽  
Author(s):  
Richard K. Freeman ◽  
Anthony J. Ascioti ◽  
Megan Dake ◽  
Raja S. Mahidhara
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Multidisciplinary Care ◽  
Cost Of Care ◽  
Lung Cancer Patients ◽  
Care Conference

Clinical outcome of chemoradiotherapy in elderly patients with non-small cell lung cancer at G.V Montgomery Veterans Affairs Medical Center

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19683-19683
Author(s):  
M. Choi ◽  
W. Chan ◽  
J. Jaiwatana ◽  
T. Khansur
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Median Survival ◽  
Concurrent Chemoradiotherapy ◽  
Medical Center ◽  
Survival Rates ◽  
The United States ◽  
Lung Cancer Patients

19683 Background: More than 2/3 of lung cancer patients are age = 65 and the proportion of elderly patients are expected to rise in the United States. However data on the use of optimal chemoradiotherapy in this group of patients are limited. Methods: All lung cancer patients = 65 years, who received both chemotherapy and radiation therapy at the G. V. Montgomery VAMC between Jan 2000 to Dec 2005, were analyzed from tumor registry and computerized medical records. Patients who only received palliative radiation therapy for bone and brain metastasis were excluded. Results: Among 652 lung cancer patients diagnose, 46 patients = 65 years received both chemotherapy and radiation therapy over the 6 year study period. The median age was 72 (range:65–84) and 70% of the patients were = 70 years. All patients were male with 65% white and 35% black population. The majority of patients were stage III (85%) while there was one stage I and six stage II patients. 41 patients (89%) were able to complete the planned radiation therapy and median dose delivered was 6140 cGy. The chemotherapy regimen was carboplatin and paclitaxel either weekly during radiation therapy and every three weeks in sequential treatment. There was only 1 treatment related mortality and only 15% of patients survived less than 6 months. The 1, 2, 3 year survival rates were 67%, 24%, and 15% respectively and median survival was 15.3 months. 15 patients were treated sequentially(S) with chemotherapy (median cycle-3) followed by radiation therapy and 31 patients concurrently (C) with chemoradiotherapy. (median- 5 weekly treatment) The survival among the two groups did not differ statistically. (median survival-19.1 month (S) vs. 14 month (C) p=0.78) Conclusions: Both sequential and concurrent chemoradiotherapy is feasible and beneficial in elderly patients with lung cancer. Sequential treatments might be as effective as concurrent chemoradiotherapy in elderly VA patient population. No significant financial relationships to disclose.

A schematic case episode format to aid in “Choosing Wisely."

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 181-181
Author(s):  
J. Russell Hoverman ◽  
B. Brooke Mann ◽  
Jad Hayes ◽  
Lalan S. Wilfong ◽  
Marcus A. Neubauer
Keyword(s):  
Lung Cancer ◽  
Time Series ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Choosing Wisely ◽  
Patient Specific ◽  
Case Review ◽  
Billing Data ◽  
Lung Cancer Patients

181 Background: The recommendations of the Choosing Wisely campaign are evidence –based strategies to reduce cost without sacrificing outcomes. Yet tying the recommendations to indicators of use at the physician and case level has been challenging. As practices become responsible for total cost of care, an easy to use analytic method to determine appropriate use will be critical. We here describe a tool for rapid assessment of individual cases to achieve that objective. Methods: The population was a payer defined cohort of lung cancer patients treated at Texas Oncology (TxO). TxO maintains a payer patient list, updated daily with demographics and diagnosis details for all enrolled patients. The list of lung cancer patients was cross-referenced against billing data from TxO's financial data warehouse (FDW). The FDW data is generated monthly, based on billing details from TxO's practice management system, and includes procedure codes and dates of service. Radiation therapy, chemotherapy, and GCSF administrations for each enrolled lung cancer patient were identified in the FDW data based on CPT codes. SAS software (version 9.4 for Windows) was used to generate a time series plot for each patient, based on date of service for each procedure. The time series plots were inserted into an Excel report template, along with general patient information, using a Visual Basic script, for review by TxO's medical director and quality committees. Results: Each patient-specific time series schematic displays elapsed weeks on the x-axis, beginning with week 1 to end of treatment. Three variables are displayed on the y-axis, using distinct colors and symbols: dates of radiation therapy (orange #), dates of GCSF administration (red x), and dates of chemotherapy administration (green ^). Each of the three y-axis variables is assigned a constant value that is plotted along a straight line. A graphic representation for a patient with stage III lung cancer could look as shown in the Table. Conclusions: Treatment episodes can be distilled into a meaningful format that allows rapid case review and the opportunity for continuous learning. Additional diseases and graphics will be available for presentation. [Table: see text]

Survival associated with cachexia among SEER-Medicare beneficiaries with lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18117-e18117
Author(s):  
Shweta Shah ◽  
Joshua Noone ◽  
Christopher Michael Blanchette ◽  
Susan T Arthur
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Median Survival ◽  
The United States ◽  
Population Characteristics ◽  
Treatment Modalities ◽  
Lung Cancer Patients ◽  
The Impact

e18117 Background: Lung cancer is the leading cause of cancer death in the United States. It is estimated that 60% of lung cancer patients are afflicted with cancer-associated cachexia syndrome (CACS) and approximately 10% of these patients will die due to CACS. We examined the impact of CACS on survival among lung cancer elderly patients. Methods: We conducted a retrospective study using SEER-Medicare data. Patients were included if diagnosed with first primary lung cancer between January 1, 2005 and December 31, 2010, at least 66 years of age, and continuously enrolled in Medicare Parts A and B in the 12 months prior to diagnosis. We identified cachexia in lung cancer patients using ICD-9 codes. Descriptive statistics were used to identify population characteristics. Propensity score (1:1 nearest neighbor) matching was performed between cachectic and non-cachectic lung cancer patients to compare survival. Results: We identified 84,518 lung cancer patients. Of these, 2,536 (3%) developed CACS after lung cancer diagnosis. The most common comorbid conditions among cachectic and non-cachectic groups were chronic obstructive pulmonary disease (50% versus 45.62%), congestive heart failure (8.56% versus 13.38%), diabetes (7.41% versus 14.75%), peripheral vascular disease (3.82% versus 6.85%), and renal disease (3.63% versus 6.14%). Propensity score 1:1 matching for confounding bias and adjustment for immortal time bias resulted in a cohort of 3734 matched patients. Eighty-eight percent of patients in the cachectic group died during the follow-up period compared to 78% in the non-cachectic group. Median survival time among non-cachectic lung cancer patients was significantly longer than cachectic lung cancer patients (log-rank p < 0.0001). Specifically, median survival in non-cachectic patients was 201 days compared to 92 days among cachectic patients. Conclusions: The occurrence of CACS is independently associated with a significant decrease in survival among lung cancer elderly patients. The results of this study may be useful for identifying healthcare burden and planning treatment modalities for this population.

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