title: The role of palliative chemotherapy in hospitalized patients.
abstract: BACKGROUND
  Hospitalized patients with advanced cancer often have a poor performance status, which is considered a relative contraindication to cytotoxic chemotherapy. We investigated outcomes in hospitalized solid tumour oncology patients who received palliative chemotherapy (pct).
  
  
  METHODS
  With ethics approval, we performed a single-institution chart review of all patients hospitalized on our oncology unit who received pct between April 2008 and January 2010. Patient demographics, reasons for admission, cancer type, prior therapy, and administered chemotherapy were recorded. The primary endpoint was median survival from date of inpatient chemotherapy until death or last known follow up. We also investigated place of discharge and whether patients received additional therapy.
  
  
  RESULTS
  During the study period, 199 inpatients received pct. Median age was 61 years; 59% of the patients were women. Most had been admitted with dyspnea (31%) or pain (29%) as the dominant symptom. Common cancers represented were breast (23%), small-cell lung cancer (sclc, 22%), non-small-cell lung cancer (nsclc, 16%), and colorectal cancer (9%). Most patients (67%) were receiving first-line chemotherapy. Median overall survival duration was 4.5 months, and the 6-month survival rate was 41%. The longest and shortest survivals were seen in the sclc and nsclc groups (7.3 and 2.5 months respectively). Factors significantly associated with shorter survival were baseline hypoalbuminemia and therapy beyond the first line. In this cohort, 77% of patients were discharged home, and 72% received further chemotherapy.
  
  
  CONCLUSIONS
  Despite a short median survival, many patients are well enough to be discharged home and to receive further chemotherapy. The development of risk models to predict a higher chance of efficacy will have practical clinical utility.
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: P
authors.initials: P
authors.lastname: Wheatley-Price
authors.affiliation: Postgraduate Medical Education, University of Ottawa, Ottawa, ON.
authors.forename: M
authors.initials: M
authors.lastname: Ali
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.
authors.forename: K
authors.initials: K
authors.lastname: Balchin
authors.affiliation: Division of Pharmacy, The Ottawa Hospital Cancer Centre, Ottawa, ON.
authors.forename: J
authors.initials: J
authors.lastname: Spencer
authors.affiliation: Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: E
authors.initials: E
authors.lastname: Fitzgibbon
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: C
authors.initials: C
authors.lastname: Cripps
keywords: Inpatients; hospitalization; palliative chemotherapy; performance status
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