2024 Eastern States Conference

TITLE: Impact of palliative chemotherapy in hospitalized adult patients with advanced solid tumors
AUTHORS: Jun Hsu, PharmD, Leila Mohassel PharmD, BCPS, BCOP, Alisa Escano, PharmD, BCPS, Kendra Jones, PharmD, BCPS, MPH, Hongkun Wang, PhD, David Heyer, MD, Danielle Shafer, DO, Sydney Roussel, PharmD student, Jane Cao, PharmD student, Lillian Babbie, PharmD student
OBJECTIVE: Assess the impact of palliative chemotherapy in hospitalized patients with advanced solid tumors. Additionally, comparing the impact between patients with an ECOG PS ≤ 2 and ECOG PS > 2
SELF ASSESSMENT QUESTION: Based on the findings of the study, how would you analyze and determine which patients are optimal candidates for the initiation of PC?
BACKGROUND: Palliative chemotherapy (PC), a tactic primarily utilized in patients with late-stage cancer to help optimize symptom control, maintain quality of life, and improve survival. However, PC initiation in hospitalized patients with late-stage disease is controversial as chemotherapy may be poorly tolerated in this population. The current recommendations from the ASCO recommends against initiating PC in patients with a poor ECOG-PS scores, which is a score > 2 in solid tumors. However, the evidence behind this recommendation is limited due to underrepresented patients with an ECOG-PS score >2.
METHODOLOGY: This retrospective study, conducted between January 1, 2018, and September 1, 2020, across five hospitals within a single health system, focused on adult patients aged 18 and above diagnosed with metastatic solid tumors and undergoing inpatient palliative chemotherapy (PC). The primary endpoint is overall survival (OS), measured from the initiation of inpatient PC until death or the last documented follow-up, assessed using a Kaplan-Meier survival curve. Secondary outcomes encompass 30-day and 60-day mortality, hospital length of stay (LOS), death during the index hospitalization, cause of death, median days between chemotherapy and death, 30-day readmission, 30-day Emergency Department (ED) visit post-chemotherapy initiation, and procedures performed during the index hospitalization.
RESULTS: Statistically significant lower overall survival in patients with an  ECOG-PS >2, compared to ECOG-PS ≤ 2 (p = 0.005) and death during index hospitalization respectively (p = 0.013). 
CONCLUSIONS: Data analyzed in this study supports the ASCO guideline recommendation against the use of PC in patients with an ECOG PS > 2