Background: Advanced lung cancer (ALC) is a symptomatic disease often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve care delivery. We aimed to identify newly diagnosed ALC patients at highest risk for subsequent healthcare utilization. Methods: We identified patients in SEER-Medicare with: ALC (stage IIIB-IV SCLC or NSCLC), diagnosed 2007-13; continuous enrollment -6 months from diagnosis through death or 12/2014; and an index hospitalization within 7 days of ALC diagnosis. Our primary outcomes were 30-day re-hospitalization and emergency department (ED) use. We used a time-to-event model with multivariate regression to identify risk factors. Results: Of ALC patients in SEER-Medicare, 54% (n=28,976) had an index hospitalization. Of those who survived to discharge, by 6 months, 47% had been re-hospitalized, and 50% had enrolled in hospice. Only 37% of patients ever received systemic treatment for their cancer, and the median time to treatment was 46 days. The 30-day ED visit and readmission rates were 13% and 35%, respectively. Pre-cancer ED use or hospitalization, SCLC, and prolonged length of stay were associated with higher risk of 30-day utilization. Palliative care consultation and discharge to hospice were associated with substantially lower risk of 30-day readmission. Conclusions: Many newly diagnosed ALC patients experience an early return to the hospital. These patients may benefit from increased access to palliative and other supportive care during index hospitalization to prevent subsequent healthcare utilization.

Select results of multivariate regression evaluating risk factors for 30-day ED use and re-hospitalization (*p-values <0.05; **p-values <0.0001)