Symptom burden in patients with cancer who are experiencing unplanned hospitalization

Abstract

Background Inpatient supportive care programs often target patients with advanced solid tumors. To the authors' knowledge, few studies to date have characterized symptom burden in hospitalized patients with potentially curable cancers. The objective of the current study was to compare symptom burden, palliative care consultation, and readmission rates in hospitalized patients by cancer type and treatment intent. Methods The authors conducted a single‐center study of hospitalized patients with cancer between 2014 and 2017. They assessed physical symptoms using the Edmonton Symptom Assessment System and psychological distress using the Patient Health Questionnaire‐4 and the Primary Care PTSD (Posttraumatic Stress Disorder) Screen. Multivariate linear regression models were used to assess symptom burden, logistic regression was used to assess palliative care use, and competing risk regression was used to compare 90‐day readmission risk. Results A total of 1549 patients were enrolled and surveyed. The majority of patients reported moderate to severe fatigue, poor well‐being, and drowsiness with no significant differences noted by cancer type and treatment intent. Compared with other groups, patients with incurable solid cancer reported higher physical symptoms (beta coefficient [B], 4.73; P < .01) and symptoms of depression (B, 0.44; P < .01) and anxiety (B, 0.39; P < .01), but no difference in posttraumatic stress disorder. Among patients in the top quartile symptom burden according to the Edmonton Symptom Assessment System, the palliative care service was consulted in 14.7%, 7.9%, 25.0%, and 49.6%, respectively, of patients with potentially curable hematologic, potentially curable solid, incurable hematologic, and incurable solid cancers (P < .001). Compared with patients with potentially curable solid cancer, patients in each group experienced a higher risk of readmission within 90 days. Conclusions Hospitalized patients with cancer experience substantial physical and psychological symptoms. Palliative care rarely is consulted for highly symptomatic patients with potentially curable cancers. Supportive care interventions should target the needs of symptomatic patients regardless of treatment intent.

Trajectories of physical symptom burden and psychological distress during the last year of life in patients with a solid metastatic cancer

“…Till December 2019, 47 (8%) patients had dropped out of the study due to refusal (24), loss of contact (4), worsening condition (14) or no specific reason (5), and 354 (59%) passed away. Of the decedents, 345 had answered at least one survey in their last year of life and constituted our study sample (Figure S1).…”

“…The literature also shows that patients with high symptoms and distress experience repeated hospitalizations, 12 although the directionality of this association remains unclear 13 . Exacerbations in patients' symptoms and distress can result in hospitalizations 14 . Concurrently, certain procedures such as surgeries or chemotherapy during planned hospitalizations can worsen symptoms and distress 15 .…”

“…13 Exacerbations in patients' symptoms and distress can result in hospitalizations. 14 Concurrently, certain procedures such as surgeries or chemotherapy during planned hospitalizations can worsen symptoms and distress. 15 Regardless, hospitalization may be indicative of a deleterious shift in patients' trajectories of symptoms and distress, and hence can be a crucial opportunity to closely monitor and manage them during and beyond the admission period.…”

Supportive oncology care at home interventions: protocols for clinical trials to shift the paradigm of care for patients with cancer

“…Hospitalized patients with advanced cancer represent a population at risk for high symptom burden and increased healthcare utilization. Elevated physical and psychological symptoms in hospitalized patients with advanced cancer are associated with increased healthcare utilization, including prolonged hospital stay and increased risk of readmissions [ 12 , 14 , 42 ]. We are conducting a single-arm pilot study ( N = 30) to evaluate the feasibility and acceptability of the Supportive Oncology Care at Home intervention for recently hospitalized patients with advanced cancer and their caregivers (NCT04637035; DFCI Protocol Number:20–414).…”

Prevalence of anxiety disorder among workers with cancer in Amman, Jordan

“…However, several factors have been reported to be linked with anxiety in patients with cancer and these includes social support, sociodemographic and socio-economics variables as well as functional status [10][11][12]. Factors associated with anxiety in patients with cancer need to be thoroughly investigated to improve their quality of life [10,13] as well as their health outcome.…”