J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 13, Number 3, March 2021, pages 177-183

Palliative Thoracic Radiotherapy for Non-Small Cell Lung Cancer in Outpatients: Reasons for Unplanned Hospitalization and Its Impact on Survival

Figure 2. Actuarial overall survival (Kaplan-Meier curves) for 32 patients with possibly treatment-related hospitalization and 104 patients with unrelated hospitalization or no hospitalization at all (P = 0.006, log-rank test).

**Table 1.** Baseline Characteristics Before Palliative Radiotherapy in 136 Patients
Variable	N (%)
COPD: chronic obstructive pulmonary disease; RT: radiotherapy.
Gender
Male	78 (57)
Female	58 (43)
History of COPD
Yes	37 (27)
No	99 (73)
Radiation dose
High	72 (53)
Intermediate, e.g., 13 fractions of 3 Gy	23 (17)
Low, largely 10 fractions of 3 Gy	41 (30)
Tumor stage
T1 and 2	51 (37)
T3 and 4	85 (63)
Lymph node stage
N0 and 1	38 (28)
N2 and 3	98 (72)
Cancer stage
II	11 (8)
III	64 (47)
IV	61 (45)
Histology
Adenocarcinoma	57 (42)
Squamous cell carcinoma	55 (40)
Other/unspecified	24 (18)
Active smoking
Yes	27 (20)
No	109 (80)
Systemic cancer treatment
Before RT	82 (60)
Concomitant to RT	48 (35)
Steroid medication
Yes	45 (33)
No	91 (67)

Table 1. Baseline Characteristics Before Palliative Radiotherapy in 136 Patients

Variable

N (%)

COPD: chronic obstructive pulmonary disease; RT: radiotherapy.

Gender

Male

78 (57)

Female

58 (43)

History of COPD

Yes

37 (27)

99 (73)

Radiation dose

High

72 (53)

Intermediate, e.g., 13 fractions of 3 Gy

23 (17)

Low, largely 10 fractions of 3 Gy

41 (30)

Tumor stage

T1 and 2

51 (37)

T3 and 4

85 (63)

Lymph node stage

N0 and 1

38 (28)

N2 and 3

98 (72)

Cancer stage

11 (8)

III

64 (47)

61 (45)

Histology

Adenocarcinoma

57 (42)

Squamous cell carcinoma

55 (40)

Other/unspecified

24 (18)

Active smoking

Yes

27 (20)

109 (80)

Systemic cancer treatment

Before RT

82 (60)

Concomitant to RT

48 (35)

Steroid medication

Yes

45 (33)

91 (67)

**Table 2.** Reasons for Hospitalization in 58 Patients (32 Possibly Related to Treatment)
Main discharge diagnosis	Number	Relation to treatment
COPD: chronic obstructive pulmonary disease.
Pneumonia	14	Possible
Palliative measures unrelated to radiation	12	Unrelated
Infection other than pneumonia	10	Unrelated
Esophagitis	6	Possible
Dyspnea with established COPD	5	Possible
Cardiac arrythmia	3	Possible
Dehydration/malnutrition	3	Possible
Hemoptysis	1	Possible
Pre-existing diabetes mellitus	1	Unrelated
Lumbago	1	Unrelated
Traumatic injury	1	Unrelated
New distant metastases	1	Unrelated

Table 2. Reasons for Hospitalization in 58 Patients (32 Possibly Related to Treatment)

Main discharge diagnosis

Number

Relation to treatment

COPD: chronic obstructive pulmonary disease.

Pneumonia

Possible

Palliative measures unrelated to radiation

Unrelated

Infection other than pneumonia

Unrelated

Esophagitis

Possible

Dyspnea with established COPD

Possible

Cardiac arrythmia

Possible

Dehydration/malnutrition

Possible

Hemoptysis

Possible

Pre-existing diabetes mellitus

Unrelated

Lumbago

Unrelated

Traumatic injury

Unrelated

New distant metastases

Unrelated

**Table 3.** Risk Factors for Unplanned Hospitalization
Parameter	Unadjusted odds ratio (95% confidence interval)	P-value (multinominal logistic regression)	P-value (univariate)
Including sex in the multinominal logistic regression analysis did not alter the results. Sex was not significantly associated with hospitalization. Tests: Chi-square test, multinominal logistic regression. RT: radiotherapy or chemoradiation.
Previous hospitalization (last 4 weeks before RT) 21 of 27 (78%) vs. 37 of 109 (34%) hospitalization	1.8 (1.4 - 2.1)	0.001	0.0001
Steroid medication when starting RT 25 of 45 (56%) vs. 33 of 91 (36%) hospitalization	1.3 (0.6 - 3.0)	0.52	0.04
Elevated serum C-reactive protein 47 of 98 (48%) vs. 11 of 38 (29%) hospitalization	1.7 (0.8 - 4.2)	0.15	0.04

Table 3. Risk Factors for Unplanned Hospitalization

Parameter

Unadjusted odds ratio (95% confidence interval)

P-value (multinominal logistic regression)

P-value (univariate)

Including sex in the multinominal logistic regression analysis did not alter the results. Sex was not significantly associated with hospitalization. Tests: Chi-square test, multinominal logistic regression. RT: radiotherapy or chemoradiation.

Previous hospitalization (last 4 weeks before RT)
21 of 27 (78%) vs. 37 of 109 (34%) hospitalization

1.8 (1.4 - 2.1)

0.001

0.0001

Steroid medication when starting RT
25 of 45 (56%) vs. 33 of 91 (36%) hospitalization

1.3 (0.6 - 3.0)

0.52

0.04

Elevated serum C-reactive protein
47 of 98 (48%) vs. 11 of 38 (29%) hospitalization

1.7 (0.8 - 4.2)

0.15

0.04