PHOENIX – Unplanned hospitalizations due to toxicities associated with head and neck cancer treatment were a source of substantial cost in a retrospective chart review of 141 patients treated at a single cancer center during 2007-2011.
Much of the increased cost was among patients who underwent docetaxel plus cisplatin and fluorouracil induction chemotherapy (TPF) plus chemoradiotherapy.
Dr. Regan D. Rostorfer
"In recent years, induction chemotherapy has been increasingly incorporated into multimodality regimens for selected patients with locally advanced primary squamous cell carcinoma of the head and neck (HNSCC) ... Although efficacious (N. Engl. J. Med. 2007;357:1705-15), TPF has the potential for toxicities [that] may lead to unplanned admissions during treatment. Concurrent use of chemotherapy with radiation is well documented to intensify therapeutic effect and toxicity," Dr. Regan D. Rostorfer and his associates said in a poster.
Symptoms leading to the unplanned readmissions during induction chemotherapy (27 readmissions, 18 patients) included dehydration (in 13 of the 27 readmissions), infection (8), diarrhea (6), nausea/vomiting (5), pain (4), and mucositis (3).
A range of strategies can be used to avoid readmissions and thereby reduce these costs, including careful patient selection, use of prophylactic antimicrobials, standardized use of growth factor support, post-treatment support with outpatient intravenous fluids, integration of home health care services, early gastrostomy-tube placement, use of long-acting antiemetics during treatment, and frequent outpatient office visits during treatment, Dr. Rostorfer and his associates said.
"A number of initiatives are ongoing at our center in efforts to decrease readmission rates during combined modality treatment. Further studies are planned to assess the impact of these measures on readmission rates, and impact on costs of care," the investigators said in their poster.
In an interview, Dr. Rostorfer said the study was initially intended to simply to gather statistics about readmission for head/neck cancer treatment-related toxicity, since there were no published data on it.
"We decided to look at data from our own institution, simply to see how frequently patients were readmitted, and the reason for readmission. More recently, costs have become an issue at almost every hospital in the country, so we decided to look at the excess costs associated with these unplanned admissions, as well.
The investigators reviewed charts for 91 randomly assigned patients with locally advanced primary HNSCC who received treatment with concurrent chemoradiotherapy, and for another 50 patients who received induction TPF chemotherapy followed by chemoradiation. The oropharynx was the most common cancer site, in 24 of the induction group (48%) and 59 of the concurrent group (65%).
A total of 19 induction patients (38%) required unplanned readmission, with 8 requiring more than one. Median length of stay for those total 27 unplanned stays was 6 days (range 1-25). In the concurrent group, 47 patients required unplanned readmission (52%), with 19 requiring more than one. That group had a total 77 unplanned readmissions, with a median stay of 7.8 days (1-65).
Total costs of admissions in the induction group were $3,368,583 for the planned admissions and $1,777,136 for the unplanned admissions. The median cost per planned hospital stay – elective admission for chemotherapy – was $32,276. In contrast, the cost per unplanned hospital stay was $42,390. For the concurrent group, which did not have planned hospitalizations, the cost per unplanned stay was $69,460, said Dr. Rostorfer, medical oncology and hematology chief fellow at MD Anderson Cancer Center Orlando, and his associates.
"Obviously this was a small, retrospective review, but the numbers can be quite alarming. We have begun to implement measures to reduce the numbers of readmission, so hopefully to reduce the cost associated with care. We will see the difference it makes."
Dr. Rostorfer stated that he has no disclosures.