Purpose: The usual workup for patients newly diagnosed with advanced non-small cell lung cancer (NSCLC) occurs in the ambulatory setting. A subset of patients present with acute care needs and receive the diagnosis while hospitalized. Palliative therapies are typically initiated when patients are outpatients, even when diagnoses are made when they are inpatients. Lengthy admission, rehabilitation needs after discharge, and readmissions are possible barriers to timely and adequate outpatient follow-up. The outcomes for these patients diagnosed in the hospital are not well characterized. We hypothesized that patients have been ill-served by current treatment patterns, as reflected by low rates of cancer-directed treatment and poor survival. Patients and methods: We performed a retrospective study of new inpatient diagnoses of metastatic NSCLC at our institution between 1 January 2012 and 1 January 2022. The primary outcome was the proportion of patients ultimately receiving cancer-directed therapy. Other outcomes included time to treatment, use of targeted therapy, palliative care/hospice utilization, and overall survival (OS). Results: Seventy-three patients were included, with a median age of 57 years. Twenty-seven patients (37%) ultimately received systemic therapy with a median time from diagnosis to treatment of 37.5 days. Overall, 5.4% patients died while admitted, 6.8% were discharged to a hospice, 21.9% were discharged to a facility, and 61.6% were discharged home. Only 20 patients (27%) received palliative care consultation. The median OS for our entire population was 2.3 months, with estimated 6-month and 1-year OS rates of 32% and 22%, respectively. Conclusion: Patients with new inpatient diagnoses of metastatic NSCLC have extremely poor outcomes. Current management strategies resulted in few patients starting systemic therapy, yet most of the patients did not receive palliative care or hospice involvement. These findings demonstrate that there is a high unmet need to optimally support and palliate these patients.
目的：新诊断的晚期非小细胞肺癌（NSCLC）患者的常规诊疗通常在门诊环境中进行。部分患者因急性护理需求在住院期间确诊。姑息治疗通常在患者处于门诊状态时启动，即使其诊断是在住院期间完成。住院时间过长、出院后康复需求以及再入院可能成为及时充分门诊随访的障碍。对于这些在院内确诊的患者，其临床结局尚未得到充分描述。我们假设当前治疗模式未能充分服务此类患者，具体表现为抗癌治疗率低且生存预后差。患者与方法：我们对2012年1月1日至2022年1月1日期间在本机构新确诊为转移性NSCLC的住院患者进行回顾性研究。主要结局指标是最终接受抗癌治疗的患者比例。其他结局指标包括治疗启动时间、靶向治疗使用情况、姑息治疗/临终关怀利用率以及总生存期（OS）。结果：共纳入73例患者，中位年龄57岁。27例患者（37%）最终接受了全身治疗，从诊断到治疗的中位时间为37.5天。总体而言，5.4%的患者在住院期间死亡，6.8%出院至临终关怀机构，21.9%出院至护理机构，61.6%出院回家。仅20例患者（27%）接受了姑息治疗会诊。全人群的中位OS为2.3个月，预估6个月和1年OS率分别为32%和22%。结论：新住院确诊的转移性NSCLC患者临床结局极差。当前管理策略导致仅少数患者启动全身治疗，且多数患者未接受姑息治疗或临终关怀介入。这些发现表明，为优化支持与缓解这些患者的症状，存在高度未满足的临床需求。
肿瘤(癌症)患者之家