Risk of hospitalizations associated with adverse effects of chemotherapy in a large community-based cohort of elderly women with ovarian cancer

Abstract

Purpose: To determine the rates of hospitalization after receiving chemotherapy in patients who were diagnosed with ovarian cancer and to examine significant predictors for hospitalizations.

Methods: We studied 9361 women who were diagnosed with stages I to IV ovarian cancer at age 65 or older in 1991 to 2002, identified from the 16 areas of the Surveillance, Epidemiology, and End Results program linked with Medicare data. Hospitalization for adverse effects associated with chemotherapy was defined using primary and secondary diagnosis codes from the inpatient claims. Multivariate logistic regression was used to estimate the risk of being hospitalized for adverse effects in patients receiving chemotherapy compared with those who did not.

Results: A total of 1363 patients (14.6% of 9361) received platinum-based chemotherapy without taxane, 3094 patients (33.1%) received platinum-taxane combination chemotherapy, 1694 patients (18.1%) administered other (nonplatinum) chemotherapy, and 3210 patients (34.3%) did not receive chemotherapy. Compared with those receiving platinum-based chemotherapy, patients receiving nonplatinum chemotherapy had a higher risk of being hospitalized for infection (odds ratio [OR], 1.66; 95% confidence interval [95% CI], 1.19-2.31), whereas patients who did not receive chemotherapy (OR, 0.16; 95% CI, 0.10-0.28) or received platinum-taxane combination chemotherapy (OR, 0.54; 95% CI, 0.34-0.86) were significantly less likely to be hospitalized for hematologic toxicities. Although both comorbidity scores and age were significant predictors for hospitalization for infection and cardiovascular diseases, older age was not a significant predictor for gastrointestinal and hematologic toxicities.

Conclusions: The nonplatinum chemotherapeutic regimens were associated with higher rates of hospitalizations for gastrointestinal and hematologic conditions or infections compared with platinum-based or platinum-taxane combination regimens. Comorbidity was a significant predictor for hospitalization for infections and gastrointestinal and cardiovascular diseases.