Mortality outcomes in hospitalized oncology patients after rapid response team activation

Abstract

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.