Factors and Costs Associated With Delay in Treatment Initiation and Prolonged Length of Stay With Inpatient EPOCH Chemotherapy in Patients With Hematologic Malignancies.
Reducing delays related to inpatient chemotherapy may reduce healthcare costs. Using a national database, we identified patients with lymphoma/leukemia with ≥1 etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy claim and evaluated chemotherapy initiation delay (ID), >1 day from admission. Standard tests/procedures prior to initiation were evaluated. Among 4453 inpatient cycles, 19.7% had ID, odds ratio 2.28 (95% confidence interval: 1.83-2.85) with cycle 1 compared to cycle 2, and mean costs were higher in patients with ID than without ID (p < .0001). Prior to cycle 1, patients were more likely to undergo routine diagnostic procedures compared to subsequent cycles. Efforts to perform routine procedures prior to admission may reduce hospital length of stay and costs.
a Department of Medicine College of Physicians and Surgeons , Columbia University , New York , NY , USA.|b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.
Melissa K
MK
Accordino
b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.|c Department of Obstetrics and Gynecology, College of Physicians and Surgeons , Columbia University , New York , NY , USA.
Jason D
JD
Wright
d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.
Sowmya
S
Vasan
a Department of Medicine College of Physicians and Surgeons , Columbia University , New York , NY , USA.|b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.|d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.
Alfred I
AI
Neugut
b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.|d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.
Grace C
GC
Hillyer
a Department of Medicine College of Physicians and Surgeons , Columbia University , New York , NY , USA.|b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.|d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.
Dawn L
DL
Hershman
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000191:economics / Q000627:therapeutic use; D004317:Doxorubicin / Q000191:economics / Q000627:therapeutic use; D005047:Etoposide / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics*; D007938:Leukemia / Q000188:drug therapy* / Q000191:economics; D008223:Lymphoma / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014750:Vincristine / Q000191:economics / Q000627:therapeutic use
D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
Chemotherapy; health sciences research; outcomes research