Mortality outcomes in hospitalized oncology patients after rapid response team activation
Background The prognosis of hospitalized oncology patients varies widely, and physicians are poor at predicting outcomes in cancer patients. Discrete signifiers of prognosis in hospitalized oncology patients are widely sought.
Objective To test the hypothesis that oncology patients who have had rapid response team (RRT) activations would have high rates of in-hospital and 100-day mortality, and that these might differ based on malignancy type and other clinical factors.
Methods A retrospective study was performed at a single, 900+ bed academic center in the northeastern United States during a 2-year study period using an RRT-specific database. We included patients 18 years or older with a cancer diagnosis, including solid tumor and hematologic malignancy, as well as those who were status post-bone marrow transplantation, who required RRT activation. Surgical and intensive care unit patients were excluded. Primary outcome variables of interest were inpatient and 100-day mortality post-RRT activation as well as the clinical variables leading up to RRT activation.
Results RRT activation was associated with a high inpatient mortality in patients with solid tumor and hematologic malignancies (43% and 35%, respectively) and a 100-day mortality (solid tumors, 78%; hematologic malignancies, 55%). In multivariate analysis, female sex was associated with significantly higher inpatient and 100-day mortality.
Limitations This retrospective review of a single center's data on oncology patients may not apply to all hospitals.
Conclusions These findings demonstrate high inpatient and 100-day mortality in a selected population of oncology patients. The event of an RRT activation may be a useful predictor of prognosis in oncology patients and can be used to help patients and families improve advance care and end-of-life planning.
Funding Cancer Center Support Grant 5P30CA056036-17 and the Biostatistics Shared Resource of Thomas Jefferson University
Accepted for publication November 20, 2018
Correspondence Neil D Palmisiano MD; Neil.palmisiano@jefferson.edu
Disclosures: The authors report no disclosures/conflicts of interest.
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0439
Limitations
Limitations of the study include its retrospective nature at a single medical center on a small group of study participants. Variables such as lactate dehydrogenase level and Eastern Conference Oncology Group Performance Status, which have been found to be predictive of increased mortality in hospitalized oncology patients,19 were not consistently available for analysis in the data set. We had 4 patients whose mortality status was not known at 100 days and were excluded from the study. Because of a lack of documentation, we were also not able to reliably collect the data on patients with multiple RRT events. This presumably would be associated with increased mortality on its own. We only included the data associated with the earliest RRT activation in our electronic health records.
In addition, it is important to note that 26% and 16% of the study patients had missing lactate and INR values, respectively. Given the small size of the study and the unclear significance of the missing lactate and INR, we opted to include the patients with the missing data for final analyses of the regression models. The significance of a care team not ordering a lactate level is perhaps associated with the reason for RRT activation (ie, the patient seemed to be less ill) and perhaps could be associated with non–sepsis-related RRT events.
Conclusions
This study reports on the outcomes of oncology patients admitted to the hospital whose clinical deterioration required activation of a rapid response team. Female sex, increased qSOFA and SIRS scores in the 24 hours preceding the RRT event, and the need for blood product administrations around the time of the RRT event correlated with increased inpatient mortality. Hospitalized oncology patients’ d undestood and response evaluation if perPatientoutcomes, both regarding inpatient and 100-day mortality, demonstrated surprisingly poor survival, with solid malignancy patients bearing significantly higher burden of both inpatient mortality and mortality at 100 days after the RRT event. The findings from the study could help patients, families, and providers make informed decisions regarding advance care and end-of-life planning for terminally ill cancer patients.
,The Cancer Center Support Grant 5P30CA056036-17 and the Biostatistics Shared Resource and Thomas Jefferson University Hospital’s Rapid Response Team (RRT) committee.
