Hospitalizations of more than 5 days predict for worse outcomes after radiotherapy for head and neck cancer

Abstract

Background Patients undergoing chemoradiation for head and neck squamous cell carcinoma (HNSCC) are predisposed to unplanned hospitalizations. Objective To assess the factors associated with prolonged hospitalization and its impact on patient outcomes. Methods We assessed the outcomes of patients hospitalized for ≥5 days or <5 days in 251 patients with advanced HNSCC who were undergoing radiotherapy during 2000-2012. Results Patients who had been hospitalized for ≥5 days were more likely to be admitted for infection, acute renal failure, and/ or dehydration. We found no other patient, tumor, or treatment characteristics associated with prolonged hospitalizations. Hospitalizations of ≥5 d were associated with a higher incidence of delays in radiotherapy (RT; odds ratio [OR], 2.49; 95% confdence index [CI], 1.09-5.69; P = .03) and worse performance status after RT (OR, 5.76; 95% CI, 1.85-18.38; P = .003). On multivariate analysis, hospitalization of ≥5 days predicted for worse local-regional control (hazard ratio [HR], 1.85; 95% CI, 1.08-3.17; P = .03) and time to treatment failure (HR, 1.64; 95% CI, 1.03-2.61; P = .04), and performance status after RT predicted for worse local-regional control, time to treatment failure, progression-free survival, and overall survival. Limitations As a retrospective review, we report only hypothesis-generating observations, which may have been affected by having incomplete patient information. Conclusions Hospitalizations of ≥5 days was associated with infections and/or dehydration and predicted for worse disease control. Our results suggest that patients may beneft from efforts to reduce hospitalization length by minimizing precipitators of hospitalizations as well as interventions to reduce the length of hospital stays.