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31-10-2011 | General practice | Article

Oral cancer complications increase hospitalizations and costs

Abstract

Free abstract

MedWire News: Complications from oral and oropharyngeal cancer treatment results in increased hospital length of stay and costs, research shows.

The overall complication rate is 15%, with patients most likely to present with bleeding complications, followed by bacterial infections, mycoses, and other infections.

"Among the different complications, septicemia was associated with the highest increase in in-hospital mortality," report Min Kyeong Lee (Harvard School of Dental Medicine, Boston, Massachusetts, USA) and colleagues.

The data, published in the journal of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, used a nationwide inpatient sample of patients discharged with a primary diagnosis of oral and oropharyngeal cancers.

Over a one-year period, there were 17,632 hospitalizations attributed to the cancers, with 519 patients (2.9%) dying in hospital.

Cancer of the tongue accounted for the most hospitalizations (n=6937), and this was followed by oropharyngeal cancer (n=3107), and cancer of the salivary gland (n=2525).

Patients admitted to hospital with a primary diagnosis of cancer of the oropharynx had the highest in-hospital mortality rate. The researchers reported that several etiologic factors were associated with oral cancers, and some of them were preventable, such as tobacco use.

They also report that the presence of comorbid conditions were a significant predictor for poor outcomes.

The costs associated with hospitalization for oral and oropharyngeal were reported at US$ 1.08 billion (€77 billion) and accounted for 117,472 days spent in the hospital. The average length of hospital stay was 6.6 days and the mean total hospital charge was US$ 62,885 (€44,927).

Cancer of the gums had the highest mean hospitalization charges at US$ 103,318 (€73,814) whereas cancers of the floor of the mouth had longest length of hospital stay at 9.57 days. Cancers of the tongue, however, were responsible for the highest total hospitalization charges at US$ 41 million (€296 million) and the most days spent in hospital (47,904 days).

"Our findings indicate that presence of complications is associated with significantly higher hospital charges, length of stay, and higher odds for mortality," write Lee and colleagues.

In a multivariate analysis, elective hospitalizations were associated with a shorter length of stay compared with patients hospitalized on an emergency basis. Cancers of the tongue, gums, and floor of mouth were all associated with longer lengths of hospital stay.

Bacterial and other infections resulting in hospitalization might be caused by intensive treatment regimens for cancer, according to the researchers. Chemotherapy, for example, may cause immunosuppression and put patients at an increased risk for developing infections and septicemia.

"Future studies must focus on identifying the risk factors leading to the occurrence of these complications and pathways that lead to better outcomes," they conclude.

By MedWire Reporters

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