Background Patients with advanced cancer often experience frequent and prolonged hospitalizations; however factors associated with greater healthcare utilization have not been described. We sought to investigate the relationship between patients’ physical and psychological symptom burden and healthcare utilization. Methods We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. Results We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over half reported moderate/severe fatigue, poor well-being, drowsiness, pain, and lack of appetite. Using the PHQ-4, 29% and 28% of patients had depression and anxiety symptoms, respectively. Mean hospital LOS was 6.3 days and 90-day readmission rate was 43.1%. Physical symptoms (ESAS: B=0.06, P<.001), psychological distress (PHQ-4 total: B=0.11, P=.040), and depression symptoms (PHQ-4 depression: B=0.22, P=.017) were associated with longer hospital LOS. Physical (ESAS: HR=1.01, P<.001) and anxiety symptoms (PHQ-4 anxiety: HR=1.06, P=.045) were associated with a higher likelihood for readmission. Conclusions Hospitalized patients with advanced cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve healthcare delivery and utilization.

Our findings suggest that on a comparative basis, orthopaedic surgery lags behind general surgery and other surgical and nonsurgical fields in terms of the representation of minorities and women. Thus, given similar capabilities and qualifications of applicants, a concerted effort could be made to recruit more diverse residents and faculty.

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.