OBJECTIVES: This US study evaluated predictors of hospitalizations and ED visits in patients with aNSCLC receiving 2L therapy following first-line (1L) chemotherapy in the immuno-oncology (IO) era.

METHODS: This retrospective cohort study of Inovalon’s MORE Registry® claims identified adult patients with aNSCLC initiating 1L systemic therapy within 6 months of diagnosis in March 2015 – December 2016. Patients with SCLC, other malignancies, <1 month follow-up, on 1L targeted therapy, and on clinical trials were excluded. The impact of key demographic and clinical characteristics on the risk of 2L hospitalizations and ED visits was evaluated by binary multiple logistic regression. Results for significant variables were reported as odds ratios (OR), where an OR >1 indicated greater risk.

RESULTS: Of 2,700 patients initiating 1L chemotherapy, 829 (31%) received 2L therapy: 539 (65%) chemotherapy, 262 (32%) IO, 28 (3%) targeted therapy. Mean age at 2L start was 65.4 years; Charlson comorbidity index score: 2.5; lines of therapy per patient: 2.4; comorbidities: 1.4; follow-up time from 1L start: 11.2 months; 48% were female; 21% insured by commercial payer; 69% had evidence of smoking cessation/counselling; 34% were hospitalized, and 50% had ED visits in 2L.

Significant predictor of 2L hospitalization was 1L hospitalization (OR=1.56, p=0.028); while longer time to 1L treatment discontinuation lowered hospitalization risk (OR=0.92, p=0.036). Predictors of increased risk of 2L ED visits included: radiation therapy (OR=1.57, p=0.004), prior additional malignancy (OR=1.75, p=0.019), and 1L ED visits (OR=1.45, p=0.042); decreased risk of ED visits: commercial insurance (OR=0.58, p=0.012) and longer time to 1L discontinuation (OR=0.91, p=0.012).

CONCLUSIONS: This real-world study demonstrated that the risk of 2L hospitalizations and ED visits was heavily influenced by the patients’ 1L journey. An improved 1L experience may benefit patients in their overall care and reduce costs to the US healthcare system.