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 Researchers found that people with advanced lung cancer receiving
chemotherapy in real-world settings were almost eight times more
likely to be hospitalized during treatment than those participating
in clinical trials, which are highly controlled and regulated.
What's more, very few clinical trials even report how often
participants are hospitalized during the research, the study authors
found.
"Clinical trials should be routinely reporting their hospitalization
rates so we know what to expect," said senior author Dr. Monika
Krzyzanowska, a medical oncologist at the Princess Margaret Cancer
Center in Toronto, Canada.
Krzyzanowska and her colleagues write in JAMA Oncology that the
number of times a person goes to the hospital with treatment
complications is important to the patient and to the hospital.
A patient's quality of life may suffer if they are hospitalized, and
a hospital's reputation or reimbursement may suffer if its patients
are repeatedly hospitalized.
"I think that (hospitalization is) actually much more common than we
ever anticipated," Krzyzanowska said.
For the new study, the researchers looked at data on how many times
patients with lung cancer were hospitalized while receiving
chemotherapy.
They searched medical databases and found five clinical trials with
a total of 3,962 people that specified how many hospitalizations
occurred, and compared them to five studies with 8,624 people
receiving chemotherapy in real-world settings.
Overall, 51 percent of the real-world patients were hospitalized
during their treatments, compared to 16 percent of those in clinical
trials.
Some of the research looked at factors related to the risk of
hospitalization like the type of chemotherapy used and hospital
performance measures, but results varied from study to study.
Based on the data, Krzyzanowska told Reuters Health that she can't
say with confidence which factors may be tied to an increased risk
of being hospitalized.
But, she said, high hospitalizations are likely to be found among
people with other types of cancers and for those on other types of
treatments.
"I think this is unfortunately a common phenomenon across disease
site and treatment regimen," Krzyzanowska said.
The researchers suggest several possible explanations for the
differences in hospitalization rates.
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First, the patients in highly selective clinical trials are
different from real-world patients, who are likely to have other
conditions in addition to cancer. In this study, people receiving
chemotherapy in real-world settings were also older, on average,
than those in clinical trials.
Another possibility is that unlike people in the real world,
complications or side effects among those in closely monitored
clinical trials are treated before they lead to hospitalizations.
Knowing how much time patients may spend in hospitals during
chemotherapy might help them and their doctors in deciding which
treatment is right, Krzyzanowska said.
"I think the low-hanging fruit is that clinical trials should start
reporting hospitalizations," she said of the findings.
With that kind of data, the researchers suggest, scientists can
calculate the risk of hospitalization per month of chemotherapy and
ultimately provide that to patients.
Krzyzanowska also said she'd like to look at what factors drive
hospitalizations among cancer patients receiving chemotherapy.
"I definitely think there is a substantial portion of people whose
symptoms can be managed earlier so they don’t end up in the
hospital," she said.
If people are concerned about their quality of life during
treatment, Krzyzanowska said, they should ask their oncologist about
the likelihood of being hospitalized because of treatment.
SOURCE: http://bit.ly/1LAzRMY JAMA Oncology, online September 17,
2015.
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