title: Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation.
abstract: Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.
authors.affiliation: Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA.
authors.forename: Rifaquat
authors.initials: R
authors.lastname: Rahman
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: David A
authors.initials: DA
authors.lastname: Reardon
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Norden
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.forename: Eudocia Q
authors.initials: EQ
authors.lastname: Lee
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: Rameen
authors.initials: R
authors.lastname: Beroukhim
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
authors.forename: Mark D
authors.initials: MD
authors.lastname: Johnson
authors.forename: E Antonio
authors.initials: EA
authors.lastname: Chiocca
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Claus
authors.forename: Brian M
authors.initials: BM
authors.lastname: Alexander
authors.forename: Nils D
authors.initials: ND
authors.lastname: Arvold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000150:complications* / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D005909:Glioblastoma / Q000150:complications* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult