Development of clinical criteria for primary oncology service involvement among solid tumor inpatients at MD Anderson Cancer Center.

Abstract

67 Background: Across the US, hospitalists increasingly manage solid tumor inpatients, yet the role of primary oncologists in this model is often undefined. At MD Anderson Cancer Center, consult rates by oncology services vary by more than two-fold across the four hospitalist-managed solid tumor departments. Primary team involvement may help support conversations about prognosis and goals-of-care while improving management of oncologic issues and treatment-related side effects, yet there are no clear standards for when oncology consults should be requested. Methods: A multidisciplinary working group of Hospital Medicine, Breast Medical Oncology (BMO), Gastrointestinal Medical Oncology (GIMO), Thoracic Medical Oncology (TMO), Head and Neck Medical Oncology (HNMO), and Sarcoma Medical Oncology (SMO) advanced practitioners and physicians developed clinical criteria for primary oncology service involvement in hospitalized solid tumor patients. Following criteria development, we conducted a retrospective chart review of patients discharged between Feb. 2025 and Jan. 2026 to determine what percentage of admissions met at least one consult criterion. We reviewed 100 charts per service providing ±10% precision at 95% confidence interval. Results: Of 400 charts reviewed, 295 (73.7%) met at least one criterion for primary oncology service involvement. The most common triggers included organ dysfunction, progression of cancer, prolonged length of stay (LOS), and recurrent admissions. The rate of patients meeting consult criteria was largely similar across populations at 70% in BMO, 73% in GIMO and THNMO and 79% in SMO. Most patients met more than one criterion. Overall, 12.5% met one criterion, 29.7% met 2-3 criteria, 30.5% met 4-6 criteria, and 1% met all 7. Conclusions: A substantial proportion of hospitalized solid tumor patients met criteria for primary oncology team involvement. These findings may inform staffing models and help standardize oncology engagement in inpatient care. Future work should evaluate whether primary oncology involvement influences outcomes such as advanced care planning documentation, discharge disposition, hospice referral, length of stay, and readmissions. Clinical criteria for primary team involvement. Theme Review Criteria Disease Trajectory Progressive metastatic disease, declining performance status, symptom burden, significant organ dysfunction, severe malnutrition, new cancer dx Goals of Care/Complexity End of life, discharge to skilled nursing facility, misalignment between prognosis and patient/family expectations Hospital Course Prolonged length of stay, frequent hospital admission, plan for new artificial nutrition (total parenteral nutrition) Acuity Acute clinical deterioration, transfer to ICU, serious treatment toxicity Treatment Related Serious treatment toxicity