The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer
Autor: | Risa L. Wong, Barbara J. Cashavelly, David P. Ryan, William F. Pirl, Joseph A. Greer, Ephraim P. Hochberg, Inga T. Lennes, Lara Traeger, Areej El-Jawahri, Sara D'Arpino, Ryan D. Nipp, Vicki A. Jackson, P. Connor Johnson, Samantha M.C. Moran, Daniel E. Lage, Jennifer S. Temel |
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Rok vydání: | 2017 |
Předmět: |
Cancer Research
medicine.medical_specialty education.field_of_study Palliative care business.industry Hazard ratio Population Patient Health Questionnaire 03 medical and health sciences 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Family medicine Internal medicine Severity of illness medicine Anxiety 030212 general & internal medicine Outcomes research medicine.symptom business education Depression (differential diagnoses) |
Zdroj: | Cancer. 123:4720-4727 |
ISSN: | 0008-543X |
Popis: | BACKGROUND Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care 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 one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [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: hazard ratio, 1.01; P < .001), and anxiety symptoms (PHQ-4 anxiety: hazard ratio, 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 health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American Cancer Society. |
Databáze: | OpenAIRE |
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