title: Patients With Advanced Non-Small Cell Lung Cancer Requiring Inpatient Medical Oncology Consultation: Characteristics, Referral Patterns, and Outcomes.
abstract: BACKGROUND
  Patients with advanced non-small cell lung cancer (NSCLC) occasionally are hospitalized at the time of initial medical oncology consultation. We investigated the characteristics and outcomes of this population.
  
  
  METHODS
  With ethics approval, we performed a retrospective analysis of patients with advanced NSCLC at our institution whose initial consult occurred while hospitalized from 2007 to 2012. This was an exploratory analysis. Multivariate survival analysis was performed using Cox regression models.
  
  
  RESULTS
  A total of 223 patients were included. Baseline demographics were as follows: median age, 65 years; 52% were female; median Charlson Comorbidity Index of 10; 69% performance status (PS) 3 to 4; 49% were current smokers; 90% had stage IV disease; and 52% had ≥ 5% weight loss. Only 24% received chemotherapy. Among those treated, the median time from diagnosis to chemotherapy was 43 days. Common reasons for not receiving chemotherapy included poor PS (72%) and patient choice (9%). Factors associated with receiving chemotherapy in multivariate analysis were good PS (odds ratio [OR], 9.01; 95% confidence interval [CI], 3.55-23.26; P < .001), no leukocytosis (OR, 3.56; 95% CI, 1.35-9.35; P = .01), and age < 70 years (OR, 6.80; 95% CI, 1.78-26.32; P = .005). Factors associated with shorter overall survival in multivariate analysis were not receiving chemotherapy (hazard ratio [HR], 2.11; 95% CI, 1.28-3.48; P = .003), PS 3 to 4 (HR, 1.51; 95% CI, 1.01-2.26; P = .045), leukocytosis (HR, 2.13; 95% CI, 1.44-3.13; P < .001), and thrombocytosis (HR, 1.46; 95% CI, 1.03-2.09; P = .036).
  
  
  CONCLUSIONS
  Patients whose first consultation with medical oncologists occurs while hospitalized are an inherently sick population. Earlier diagnosis and referral would give more patients access to treatment options before a terminal functional decline.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Joanna
authors.initials: J
authors.lastname: Gotfrit
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Tinghua
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Ottawa Hospital Cancer Centre, Ottawa, Canada.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zanon-Heacock
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Ottawa Hospital Cancer Centre, Ottawa, Canada. Electronic address: pwheatleyprice@toh.on.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Wheatley-Price
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000401:mortality; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009367:Neoplasm Staging; D044382:Population Groups; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Chemotherapy; Consult; Inpatient; NSCLC; Referral