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Occurrence and Characteristics of Hospitalizations During First-Line Chemotherapy Among Individuals with Metastatic Colorectal Cancer

Authors Fisch MJ, Grabner M, Mytelka DS, Raval AD, Bowman L, Kern DM, Churchill C, Singer J, Wetmore S, Barron J, Eleff M

Received 12 July 2019

Accepted for publication 29 January 2020

Published 3 March 2020 Volume 2020:12 Pages 1535—1541


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Michael J Fisch,1 Michael Grabner,2 Daniel S Mytelka,3 Amit D Raval,2 Lee Bowman,3 David M Kern,2 Collin Churchill,3 Joseph Singer,2 Stewart Wetmore,3 John Barron,2 Michael Eleff4

1AIM Specialty Health, Chicago, IL, USA; 2HealthCore, Inc., Wilmington, DE, USA; 3Eli Lilly and Company, Indianapolis, IN, USA; 4Anthem, Inc., Indianapolis, IN, USA

Correspondence: Michael Grabner
HealthCore, Inc., 123 Justison St, Suite 200, Wilmington, DE 19801, USA
Tel +1 302-230-2000
Fax +1 302-230-2020

Objective: Choosing chemotherapy for metastatic colorectal cancer (mCRC) requires balancing clinical effectiveness and risk of complications. This study characterized real-world inpatient/emergency department (ED) hospitalizations during first-line chemotherapy among individuals with mCRC.
Methods: This retrospective cohort study used data from medical and pharmacy claims. All patients had mCRC with ≥ 1 claim for ≥ 1 of the 5 most frequently utilized first-line chemotherapy agents (fluorouracil, oxaliplatin, bevacizumab, irinotecan, capecitabine). The main outcome was all-cause hospitalizations (inpatient or ED setting) identified from claims via ICD-9/10-CM coding from index date until 30 days after the end of first-line chemotherapy or last available data.
Results: A total of 717 individuals (mean age 55 years; 58% male; ECOG 0/1/2+/missing in 44%/39%/6%/11%; median follow-up 116 days) met study criteria. Thirty-four distinct chemotherapy regimens were used. Overall, 40% of patients had ≥ 1 hospitalization (n=285; total 415 hospitalizations); 12% (n=85) had ≥ 2 hospitalizations. The median time to first hospitalization was 52 days; median inpatient length of stay was 4 days; infections/neutropenia (21%) and bowel-related complications (17%) were the most common issues associated with inpatient hospitalizations. In univariate analyses, insurance plan type, geographical location, ECOG, and renal disease were associated with hospitalization. In multivariable analyses, ECOG ≥ 1 was associated with a 67% increase (p< 0.01) in the odds of hospitalization vs ECOG= 0.
Conclusion: Approximately 40% of patients with mCRC were hospitalized during the study period. Hospital stays were typically short. Further research is needed to determine how many of these hospitalizations may be avoidable. We also observed a large amount of variation in regimens used in the first-line setting.

Keywords: colorectal cancer, chemotherapy-associated hospitalization, outcomes research, observational study, claims analysis

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