Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer.

Autor:	Lage DE; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Nipp RD; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., D'Arpino SM; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Moran SM; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Johnson PC; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Wong RL; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Pirl WF; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Hochberg EP; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Traeger LN; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Jackson VA; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Cashavelly BJ; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Martinson HS; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Greer JA; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Ryan DP; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., Temel JS; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL., El-Jawahri A; Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2018 Jan 01; Vol. 36 (1), pp. 76-82. Date of Electronic Publication: 2017 Oct 25.
DOI:	10.1200/JCO.2017.74.0340
Abstrakt:	Purpose Patients with advanced cancer experience potentially burdensome transitions of care after hospitalizations. We examined predictors of discharge location and assessed the relationship between discharge location and survival in this population. Methods We conducted a prospective study of 932 patients with advanced cancer who experienced an unplanned hospitalization between September 2014 and March 2016. Upon admission, we assessed patients' physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4). The primary outcome was discharge location (home without hospice, postacute care [PAC], or hospice [any setting]). The secondary outcome was survival. Results Of 932 patients, 726 (77.9%) were discharged home without hospice, 118 (12.7%) were discharged to PAC, and 88 (9.4%) to hospice. Those discharged to PAC and hospice reported high rates of severe symptoms, including dyspnea, constipation, low appetite, fatigue, depression, and anxiety. Using logistic regression, patients discharged to PAC or hospice versus home without hospice were more likely to be older (odds ratio [OR], 1.03; 95% CI, 1.02 to 1.05; P < .001), live alone (OR, 1.95; 95% CI, 1.25 to 3.02; P < .003), have impaired mobility (OR, 5.08; 95% CI, 3.46 to 7.45; P < .001), longer hospital stays (OR, 1.15; 95% CI, 1.11 to 1.20; P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR, 1.02; 95% CI, 1.003 to 1.032; P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR, 1.13; 95% CI, 1.01 to 1.25; P < .027). Patients discharged to hospice rather than PAC were more likely to receive palliative care consultation (OR, 4.44; 95% CI, 2.12 to 9.29; P < .001) and have shorter hospital stays (OR, 0.84; 95% CI, 0.77 to 0.91; P < .001). Patients discharged to PAC versus home had lower survival (hazard ratio, 1.53; 95% CI, 1.22 to 1.93; P < .001). Conclusion Patients with advanced cancer who were discharged to PAC facilities and hospice had substantial physical and psychological symptom burden, impaired physical function, and inferior survival compared with those discharged to home. These patients may benefit from interventions to enhance their quality of life and care.
Databáze:	MEDLINE
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