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Predictors of Unplanned Hospitalizations in Patients With Nonmetastatic Lung Cancer During Chemotherapy

Kristen L. Fessele
Matthew J. Hayat
Robert L. Atkins
ONF 2017, 44(5), E203-E212 DOI: 10.1188/17.ONF.E203-E212

Purpose/Objectives: To determine predictors of unplanned hospitalizations in patients with lung cancer to receive chemotherapy in the outpatient setting and examine the potential financial burden of these events.


Design: Retrospective, longitudinal cohort study.


Setting: The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database.


Sample: Of 104,388 incident cases of lung cancer diagnosed from 2005–2009, 2,457 cases of patients with lung cancer who received outpatient chemotherapy were identified. Patients were aged 66 years or older at diagnosis, had uninterrupted Medicare Part A and B coverage with no health maintenance organization enrollment, and received IV chemotherapy at least once.


Methods: Generalized estimating equations was used.


Main Research Variables: Patient age, sex, race, marital status, degree of residential urbanization, median income, education level, stage, receipt of radiation therapy, and comorbidities.


Findings: Younger age, non-White race, lower education, higher income, receipt of radiation therapy, and lack of preexisting comorbidity were significant predictors of the likelihood of an initial unplanned hospitalization for lung cancer. Non-White race, receipt of radiation therapy, and comorbidity were factors associated with an increased number of hospitalizations. 


Conclusions: Unplanned hospitalizations are frequent, disruptive, and costly. This article defines areas for further exploration to identify patients at high risk for unexpected complications. 


Implications for Nursing: This article represents a foundation for development of risk models to enable nursing evaluation of patient risk for chemotherapy treatment interruption and unplanned hospitalization.

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