The effect of hospitalization during first chemotherapy and performance status on small cell lung cancer outcomes

Abstract Objectives Small cell lung cancer (SCLC) is highly responsive to chemotherapy (CT) and one of the few malignancies treated in hospitalized patients with poor performance status (PS). Due to little current information on the outcomes experienced by hospitalized SCLC patients receiving CT we aimed to explore outcomes for these patients and improve the evidence base for practice. Methods We conducted a retrospective cohort study evaluating patients diagnosed with SCLC and treated with CT over 10 years. Progression free survival (PFS) and overall survival (OS) were evaluated based on site of first CT (inpatient versus outpatient) and PS. Multivariable analysis was completed to assess for independent survival predictors. Results 530 SCLC patients were treated, with 82 (15%) receiving their first CT in hospital. Inpatients had a higher burden of disease and poorer PS. Neutropenia, thrombocytopenia, nephrotoxicity, and fatigue were all experienced less often by the inpatient cohort, (p Conclusion SCLC patients initially treated as inpatients and those with poor functional status had shorter PFS and OS, but some experienced long term survival, including 5-year survival of 7% of the inpatient cohort and 5% for the ECOG PS 3-4 cohort. CT toxicities were less common in the inpatient cohort. This validates that administration of CT in hospital should be considered for these patients as they may have a meaningful long-term response to therapy