Home Discharge Less Burdensome Than Inpatient Care for Patients With Advanced Cancer

11/09/17

A recent comparative study examined predictors of discharge location for patients with advanced cancer and assessed the relationship between discharge location and survival.

Care transitions for patients with advanced cancer—particularly hospitalizations or transfers in sites of care—can be psychologically burdensome, lead to poor quality of care at the end of life, and increase health care costs. Postacute care, hospice, or home without hospice are all sites of care options for patients with advanced cancer.

Daniel E Lage, MD, Massachusetts General Hospital, and colleagues conducted a study to assess where patients with advanced cancer were discharged to and the resulting impact on psychological burden and survival outcomes. The prospective study included 932 patients who experienced an unplanned hospitalization from 2014 to 2016. Upon hospitalization, researchers assessed patient physical symptoms and psychological distress using the Edmonton Symptom Assessment System-Revised (ESAS-r) and Patient Health Questionnaire-4 (PHQ-4).

Results of the study were published in the Journal of Clinical Oncology (online October 25, 2017; doi:10.1200/JCO.2017.74.0340).

Researchers reported that approximately 78% of patients were discharged home without hospice, 12.7% were discharged to postacute care, and 9.4% were discharged to hospice. Those who were discharged to postacute care experienced high rates of psychological and physical burden, including constipation, fatigue, dyspnea, low appetite, depression, and anxiety.

Those discharged to postacute care or hospice were significantly more likely to live alone, be older in age, have impaired mobility, have a longer hospital stay, have a higher PHQ-4 score, and have a higher ESAS-r score compared with those discharged to the home without hospice. Patients discharged to postacute care had lower survival rates than those discharged to home without hospice.

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Additionally, researchers reported that patients discharged to hospice care were more likely to receive palliative care consultations and have shorter hospital length of stay than those discharged to postacute care. Authors of the study noted that patients discharged to postacute care or hospice care had similar ESAS-r and PHQ-4 scores as those discharged to home without hospice, but accommodations were unavailable in these facilities that could help improve the quality of life of the patients.

“Future research should focus on developing targeted interventions to address the functional, social, and symptomatic needs of this population,” authors of the study concluded.—Zachary Bessette