Search for prognostic markers of mortality in inpatients receiving palliative chemotherapy

In many cases, cancer is diagnosed during hospital admission. The rapid development of the cancer can, sometimes, make medical oncologist consider to start chemotherapy treatment (ChT) in an inpatient setting to seek quick symptomatic improvement. However, it remains unclear which patients are going to benefit from this approach. Our purpose is to find prognostic factors that can predict which patients are unlikely to benefit from palliative ChT, helping to avoid unnecessary or harmful treatments and focus care on improving quality of life.

A retrospective, observational analysis was completed of 209 patients with metastatic or locally advanced and unresectable disease that received ChT in inpatient regimen with palliative intent. Traditional clinical parameters (ECOG-PS, Charlson Comorbidity Index-CCI, G8 score) and other novel one (neutrophil-lymphocyte ratio-NLR) were recovered and evaluated at the start of inpatient treatment. 30 and 90 day survival were selected as efficacy outcomes.

30 and 90 day mortality rates were 22.5% and 39.2%, respectively, for the inpatients starting treatment. ECOG-PS 0-1 was associated with improved 30 and 90 day survivals in comparison with worse ECOG-PS ≥ 2. On the other hand, CCI and G8 score were not related to statistically significant differences in 30 and 90 day survival. NLR < 5 was associated with better 30 and 90 day survival in inpatients starting ChT.

NLR may be added to ECOG-PS in the choice of inpatients that can benefit from starting treatment during the hospital stay. However, further prospective studies should be carried out to bring light to this matter. The accurate selection of patients is essential to optimize symptoms control and avoid unnecessary treatment toxicity.