Care Outcomes Among Hospitalized Patients With Cancer: A Retrospective Cohort Study.

Abstract

Background: Patients with cancer often require hospital-level care to address urgent needs and symptom concerns. However, little research has sought to identify patient factors, particularly rural-urban residence, associated with care outcomes in this population.

Methods: We conducted a retrospective cohort study including adult patients with cancer admitted to the University of Oklahoma Medical Center from January 2017 through December 2022. We extracted patients' sociodemographic (ie, age, sex, race, ethnicity, rural-urban residence [Rural-Urban Continuum Codes]) and clinical (ie, Charlson comorbidity index [CCI] score, cancer type, metastatic disease status) information from the electronic health record. We used multivariable models to explore associations of patient factors with clinical outcomes (time to hospital discharge for length of stay [LOS], time to first readmission, and time to death [overall survival]).

Results: We identified 20,683 patients in our cohort (mean [SD] age, 62.6 [15.4] years; 52% female sex, 40% with a CCI score ≥3, 41% with metastatic cancer, 31% with nonmetropolitan residence). Median hospital LOS was 4.0 days, with 30- and 90-day readmission rates of 15% and 23%, and median survival was 5.0 years. Older age (hazard ratio [HR], 0.93; P<.001), male sex (HR, 0.94; P<.001), higher comorbidity (CCI score ≥3: HR, 0.70; P<.001), and metastatic disease (HR, 0.88; P<.001) were associated with longer LOS. Higher comorbidity (CCI score ≥3: HR, 2.70; P<.001) was associated with a greater risk of readmission. Older age (HR, 1.50; P<.001), CCI score ≥3 (HR, 1.68; P<.001), and nonmetropolitan residence (HR, 1.08; P=.007) were associated with worse survival.

Conclusions: In this cohort of hospitalized patients with cancer, we identified associations of patients' sociodemographic and clinical factors with their hospital LOS, risk of readmission, and survival. Findings from this work could help inform targeted efforts to enhance care delivery and outcomes for this population.