Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study

Abstract

Context: Palliative care in oncology provides multiple benefits, however access to specialty palliative clinicians is limited in community cancer centers. Individual support services are more often available, but little is known on the utilization and impact of these services. Objectives: To describe the utilization of outpatient support services in the advanced cancer population and the association with ED and hospital use in a community setting. Methods: A retrospective chart review of 314 patients with advanced cancer of lung, gastrointestinal, genitourinary, and gynecologic origin was conducted. Data collected included demographics, descriptive data, type and number of support services (symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor) within 90 days of diagnosis and descriptions of ED visits/hospitalizations within 12 months of diagnosis. Support services were available to patients by referral. Results: 29.6% of patients were deceased within 6 months and were considered to have severe disease. Patients with severe disease had a significantly greater mean number of support services than patients with non-severe disease (8.9 vs 6.0, p=0.001) and had a greater mean number of visits per year to the ED (6.4 vs 1.8, p<0.001). A greater proportion of patients with severe disease had palliative consultations (48.9% vs 21.7%, p<0.001), but 65.5% of palliative consultations occurred after an ED or hospital visit. Conclusion: Our data demonstrated that advanced cancer patients with severe disease had increased healthcare utilization in all areas measured. Despite high utilization, outpatient support services used in a reactive manner were not effective in reducing ED or hospital visits.

Health care utilization among patients with oesophageal and gastric cancer: the impact of initial treatment strategy and assignment of a contact nurse

“…One notable aspect of the results is that those with a palliative treatment strategy and those with no tumour-directed treatment used more acute health care than did patients with a curative treatment strategy (Table 4 ). This is in line with results from previous studies that identified high use of unplanned health care among patients with incurable cancer [ 17 , 18 , 34 ]. Studies by Craigs et al (2018) and Grande et al (2002) showed that regular contact with an oncology specialist was associated with increased access to both community and hospital-based palliative care and referral to palliative home care [ 35 , 36 ].…”

“…According to the ASCO, high care quality is characterized by low frequency of ED visits and hospitalizations and high rate of hospice enrolment [ 16 ]. Despite the recognized need for proactivity, studies indicate that acute health care is common among patients with advanced cancer [ 17 , 18 ]. A cross-national study on patients dying from cancer in seven developed countries reports that 44–64% were admitted to acute care hospitals and 28–58% visited the ED in the final month of life [ 19 ].…”

Supporting diversity in person-centred care: The role of healthcare chaplains

“…Healthcare chaplaincy is considered a ‘support service’ 56 (p. 34) and a component of Mertens et al’s 1 (p. 3681) description of a ‘fluid’ team of ‘collaborating professionals’ which, given the increasingly complexity of illness, is likely to be a more widespread approach for the future. In this fluidic environment, enabling professionals to work together in the pursuit of high-quality care can prove challenging.…”

Predictive factors of basic palliative and hospice care among patients with cancer visiting the emergency department in a Hungarian tertiary care center

“…Patients with advanced cancer have been shown to utilize the and inpatient healthcare services, even despite high utilization of other outpatient support services [ 35 ]. According to a recent study in the US, patients with advanced cancer presented to the ED despite recommendations for early provision of palliative care, from which 6.5 % of the patients had received palliative and 1.3 % prior hospice care [ 36 ].…”