Risk of Unplanned Hospital Encounters in Patients Treated With Radiotherapy for Head and Neck Squamous Cell Carcinoma.
CONTEXT
Radiotherapy is highly effective for treating squamous cell carcinoma of the head and neck but is often associated with significant toxicities and severe morbidity. Unplanned emergency department (ED) visits and hospitalizations are common during treatment and come with a substantial financial and health burden as well as the potential for impaired long-term outcomes due to treatment disruption.


OBJECTIVES
The objective of this study was to identify patient, disease, and treatment characteristics that were associated with ED encounters and admissions.


METHODS
A cohort of 462 patients with cancer of the head and neck treated with radiotherapy at UT Southwestern between 2010 and 2015 was retrospectively analyzed. The risks of ED visits, admissions, multiple admissions, and extended admissions were determined. Risk factors for an unplanned hospital encounter were analyzed using univariate and multivariate logistic regression.


RESULTS
Overall, 36% of patients had an unplanned hospital encounter during the treatment window. Patients with advanced disease, those with high comorbidity score, and those treated with concurrent chemotherapy were more likely to have unplanned admissions/ED visits. Social factors such as marital status, smoking status, and registration in the public hospital system were also strongly associated with admissions and multiple encounters.


CONCLUSION
The high rate of admissions and ED visits emphasizes the importance of anticipating and managing toxicities during treatment. Social factors have a strong association with unplanned encounters and may present opportunities for targeted interventions to reduce admissions for patients at highest risk.
['Moore|Zachary R|ZR|', 'Pham|Nhat-Long|NL|', 'Shah|Jennifer Lobo|JL|', 'Nedzi|Lucien|L|', 'Sumer|Baran D|BD|', 'Day|Andrew T|AT|', 'Khan|Saad A|SA|', 'Sher|David J|DJ|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D004636:Emergency Service, Hospital D005260:Female D006258:Head and Neck Neoplasms D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies D000077195:Squamous Cell Carcinoma of Head and Neck
Hospitalizations chemoradiation complications head and neck cancer radiation therapy