Trends and Predictors of In-Hospital Mortality, Length of Stay and Hospitalization Costs among Oral and Oropharyngeal Cancer Patients

Background : Oral cavity cancer (OCC) and oropharyngeal cancer (OPC) are associated with late diagnosis, significant morbidity and high mortality rates. This study investigates the trends and predictors of hospitalization outcomes including in-hospital mortality (IHM), length of stay (LOS), and hospitalization costs (HC) among adult oral cancer patients in Alberta, Canada. Methods : This 8-year retrospective, population-based, cohort study utilized administrative data from the Alberta Cancer Registry (ACR) and Canadian Institute for Health Information Discharge Abstract Database (DAD). The study population consisted of 1244 adult patients (>18 years) diagnosed with a single primary OCC or OPC between January 2010 and December 2017. The association between outcomes and independent variables was examined using multivariable regression analysis and quantile regression models. Results : For 1244 patients included, 2228 hospitalization visits were recorded with 251 (11.3%) of them resulting in death in-hospital. The trend of in-hospital mortality showed a slight decrease from 2010-2017 with a higher number of deaths recorded for OCC (13.1%) as compared to OPC (9.5%) patient visits. Significant predictors included older age, OPC, stage IV cancer, and radiation or no treatment. Patients had a mean (median) length of stay of 13.5 (9) days costing 30,807.92 (15,414.77) CAD per visit. LOS demonstrated a decreasing trend and HC increased with consistently higher costs incurred for OCC as compared to OPC visits. Risk factors for LOS included older age, higher comorbidity index, and advanced cancer stage. Hospitalization costs were significantly higher in patients with advanced cancer stages and lower in those undergoing radiation or no treatment (palliative care). Additionally, patients with OPC and those undergoing chemoradiation experienced both shorter hospital stays and lower hospitalization costs at the median. Conclusion : Given the increasing trend of hospitalization costs and elevated in-hospital mortality rates, our study results may be used to assess the current state of oral cancer care in hospitals so that targeted interventions may be developed to improve patient outcomes and reduce the health system burden.