Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer

Lage, Daniel E; Nipp, Ryan David; DʼArpino, Sara; Moran, Shannon; Johnson, Patrick Connor; Wong, Risa Liang; Pirl, William F.; Hochberg, Ephraim P.; Traeger, Lara; Jackson, Vicki A.; Cashavelly, Barbara J.; Martinson, Holly S; Greer, Joseph A.; Ryan, David P.; Temel, Jennifer S.; El‐Jawahri, Areej

doi:10.1200/jco.2017.74.0340

Cited by 35 publications

(41 citation statements)

References 49 publications

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“…We found no signifi- cant effects on hospital length of stay, yet the hazard ratio for IMPROVED to decrease patients' risk of unplanned hospital readmissions demonstrates promising potential meriting further investigation. Moreover, patients' symptoms represent just one of the many factors affecting hospital length of stay and readmissions [1,2]. Issues such as functional impairment, inadequate social support, and comorbid conditions likely place certain patients at greater risk for prolonged hospitalizations and unplanned readmissions [7,21].…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated hospital length of stay and unplanned hospital readmissions. To account for mortality, given that patients who die following hospital discharge have less time at risk for readmission, we used time to first unplanned readmission within 30 days of hospital discharge as the outcome measure, consistent with prior work [1,2]. We censored patients without a readmission at their 30-day postdischarge date and those who died within 30 days at their death date.…”

Section: Health Care Utilizationmentioning

confidence: 99%

“…Patients with cancer experience many physical and psychological symptoms that are often under-recognized by their clinicians [1,2]. Symptoms such as pain, dyspnea, fatigue, and nausea lead to poor quality of life (QOL) and psychological distress [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer

et al. 2019

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Background: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. Patients and methods: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). Results: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B ¼ 0.12, P ¼ 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment Systemphysical symptoms (B ¼ 0.07, P ¼ 0.138). Intervention patients had lower readmission risk (hazard ratio ¼ 0.68, P ¼ 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B ¼ 0.16, P ¼ 0.862). Conclusions: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk. ClinicalTrials.gov identifier NCT02891993

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Section: Discussionmentioning

confidence: 99%

Section: Health Care Utilizationmentioning

confidence: 99%

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Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer

et al. 2019

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“…We categorized the severity of ESAS-r scores as none (0), mild (1-3), moderate (4-6), and severe (7-10), consistent with prior research. [24][25][26] Also consistent with prior work, we computed composite ESAS-r physical and ESAS-r total symptom variables, which included summed scores of patients' physical and total symptoms. [22][23][24][25][26] We used the Geriatric Depression Scale (GDS-15) to assess depression symptoms.…”

Section: Physical and Psychological Symptom Burdenmentioning

confidence: 99%

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Nipp

Thompson

Temel

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes. Methods: This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival. Results: Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08–5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14–4.48; P=.020). Conclusions: Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.

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“…Most studies have focused on the immediate use of post-acute care after cancer therapy. 4,6,[19][20][21] Our study extends the estimates of post-acute care use up to 5 years after surgery, examining the long-term post-acute care needs in older cancer survivors, demonstrating increased use with age, stage, and the intensity of treatment. The high incidence in stage III was associated with the type of treatment received, particularly ostomies and/or adjuvant chemotherapy or radiation.…”

Section: Discussionmentioning

confidence: 56%

Post‐Acute Care among Older Adults with Stage I to III Colorectal Cancer

Kenzik

Williams

Bhatia

et al. 2018

J American Geriatrics Society

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BACKGROUND Little information is available on the long‐term use of post‐acute care among older patients with colorectal cancer (CRC), relative to individuals without cancer. This study examines the use of post‐acute care among older cancer survivors (>65 y) with CRC and compares it with noncancer patients up to 5 years from surgery. DESIGN Retrospective cohort. SETTING SEER‐Medicare. PARTICIPANTS Patients treated for stage I to III CRC between January 1, 2000, and December 31, 2011 (n = 40 812) and noncancer Medicare beneficiaries hospitalized for noncancer treatment matching on age, sex, race, comorbidity, and Medicaid dual eligibility. MEASUREMENTS Incident post‐acute care claims (skilled nursing, long‐term care facility, and home health) from 0 to 100 days, 101 to 365 days, and 1 to 5 years from hospitalization. RESULTS The median age was 77 years. All patients had surgery, 34% received chemotherapy, and 27% received surgery and adjuvant therapy. The cumulative incidence of any post‐acute care within 100 days of hospitalization was 45.7% for stage III, 37.9% for stage I/II, and 39% for controls (p < .001). Within the CRC cohort only, the cumulative incidence of post‐acute care was 2.9% (stage I/II) and 4.2% (stage III, p < .001) from 101 to 365 days and 15.8% (stage I/II) and 16.9% (stage III, p < .001) from 1 to 5 years. Increasing age, ostomies, and neoadjuvant or adjuvant therapy were associated with increased hazard of all post‐acute patients within 100 days from hospitalization. From 1 to 5 years from diagnosis, adjuvant therapy was associated with greater exclusive home health care use. CONCLUSIONS Survivorship planning among older CRC patients should include discussions of post‐acute care following cancer therapy, even several years after treatment. J Am Geriatr Soc 67:937–944, 2019.

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Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer

Cited by 35 publications

References 49 publications

Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer

Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Post‐Acute Care among Older Adults with Stage I to III Colorectal Cancer

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