Health Care Utilization High for Hospitalized Patients With Advanced Cancer

11/16/17

According to a recent study, symptom burden tends to be high among hospitalized patients with advanced cancer, which leads to increased use of health care resources.

Despite efforts to limit hospitalizations among patients with advanced cancer, frequent and prolonged hospitalization rates are still high in this population. However, the factors associated with increased health care utilization are not yet fully understood.

Ryan D Nipp, MD, MPH, division of hematology and oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and colleagues conducted a study to investigate the relationship between patient physical and psychological symptom burden and health care utilization in advanced cancer. A total of 1036 patients were enrolled with advanced cancer and unplanned hospitalizations from 2014 to 2016. Researchers assessed for patient physical and psychological symptoms upon admission into the study through use of the Edmonton Symptom Assessment System (ESAS) and the Patient Health Questionnaire 4 (PHQ-4), respectively.

Researchers examined the correlation between symptom burden and health care utilization by using linear regression for hospital length of stay and Cox regression for time to first unplanned readmission within 90 days. Results of the study were published in Cancer (online October 23, 2017; doi:10.1002/cncr.30912).

Researchers noted that more than 50% of the patient population reported moderate to severe fatigue, poor well-being, drowsiness, pain, and lack of appetite.

Results of the PHQ-4 indicated that 28.8% of patients had depression and 28.0% of patients had anxiety symptoms. Mean hospital length of stay totaled 6.3 days, and the 90-day unplanned readmission rate was 43.1%.

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After adjusting linear regression and Cox regression models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type, researchers found that physical symptoms, psychological distress, and depression symptoms were associated with longer hospital length of stay. Likewise, physical and anxiety symptoms were associated with a higher chance for unplanned readmission.

Authors of the study concluded that hospitalized patients with advanced cancer experience high rates of symptom burden, which significantly correlates with prolonged hospitalizations and unplanned readmissions. “Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization,” they wrote.—Zachary Bessette