Clinical Deterioration Factors of Hospitalized Cancer Patients Identified

Researchers call for early warning system to improve the care of cancer inpatients.

Several factors are associated with clinical deterioration of hospitalized cancer patients, with implications for patient monitoring, allocation of care resources, testing, and early warning systems, recent research shows.

Hospitalization is a leading contributor to cancer-related healthcare spending. Hospitalizations for cancer involve longer length of stay and higher costs than inpatient care for other conditions.

The recent research published in Journal of Oncology Practice was based on data collected from more than 21,000 hospital admissions at Barnes-Jewish Hospital in St. Louis. Clinical deterioration of cancer patients was defined as a composite of oncology ward death and intensive care unit transfers.

The research features several key data points:

• Clinical deterioration of cancer patients was relatively common, at 9.2% of admissions
   
• 6.4% of cancer patients admitted to the hospital experienced at least one ICU transfer
   
• 2.7% of cancer patients admitted to the hospital died in an oncology ward
   
• Factors associated with clinical deterioration included age, comorbidities, illness severity, emergency admission, bacteremia, and administration of antimicrobials and transfusions

The relatively high rate of clinical deterioration among cancer patients calls for an increased focus on high-risk patients, the researchers wrote. "Our findings suggest that inpatients with active cancer are at increased risk for clinical deterioration. This risk is particularly important, because prior work has shown that patients with cancer who develop critical illness may have worse outcomes than patients without cancer whose health deteriorates similarly."

Identifying cancer patients who are at high risk of clinical deterioration can generate significant care benefits, the researchers wrote. "Identification of patients on the wards before deterioration may offer the opportunity for interventions aimed to prevent ICU transfer, cardiopulmonary arrest, and death. Early intervention has been associated with improved short-term and long-term outcomes among patients with cancer whose health is deteriorating."

Early warning system
 

Cancer inpatients at high risk for clinical deterioration should be targeted for enhanced monitoring such as telemetry and differential vital sign monitoring, the lead author of the research told HealthLeaders. There are three reasons to establish early warning systems to monitor the health status of cancer inpatients, said Patrick Lyons, MD, a fellow in the Division of Pulmonary and Critical Care Medicine at Washington University School of Medicine, St. Louis, Missouri.

"First, their higher baseline risk means a well-performing early warning system would generate fewer false positive results, which are known to be harmful. Second, some literature suggests that subjective triage of oncology patients is uniquely challenging, so an objective risk prediction score might be able to help with triage. Finally, certain groups oncology patients—especially those with hematologic malignancies and recipients of stem cell transplants—commonly experience reversible deterioration, like sepsis, and ultimately recover good functional status. This suggests that some aspects of their critical illness might be modifiable if caught earlier," he said.

Lyons and his research colleagues are in the process of developing an early warning system for cancer inpatients, he said. "We are working to create an oncology early warning system and intend to test its performance, issues related to implementation and workflow integration, and ultimately patient outcomes. So, I am hopeful that our work will help develop a broad field of inquiry into how best to deliver inpatient care to such an important patient population."