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Patients with Curable Cancer Experience Significant Symptom Burden and Hospitalization

August 2017, Vol 10, Special Issue: Payers’ Perspectives in Oncology: ASCO 2017 Highlights - Value-Based Care

Chicago, IL—Providing relief from the symptoms and stress of serious illness can significantly reduce the cost of care in addition to improving the patient experience.

The results of a new study presented at the 2017 ASCO annual meeting suggest that patients with curable cancer and unplanned hospital admissions experience a substantial symptom burden, and the extent and severity of these symptoms can predict prolonged hospitalizations.

According to Patrick Connor Johnson, MD, an internist in Boston, and colleagues, these findings could inform interventions targeting patients’ symptoms in an effort to improve healthcare delivery and utilization.

“Based on these results, patients with curable cancer also need to be looked at in terms of palliative care and symptom burden,” said Dr Johnson. “Maybe we need to do a little bit more with these patients than we ­already do.”

“Patients’ symptoms are modifiable risk factors. If they’re addressed properly, we can improve care delivery and potentially help decrease hospital length of stay,” Dr Johnson added.

Although there have been studies examining the relationship between symptom burden and hospital length of stay, such studies have largely focused on patients with incurable cancer, said Dr Johnson.

“The curable cancer patient population is less studied in terms of symptom burden, and how it affects their overall experience and hospital length of stay,” said Dr Johnson.

Palliative Care Needed for Patients with Curable Cancer

For this study, Dr Johnson and colleagues prospectively enrolled patients with curable cancer and unplanned hospital admissions between August 2015 and December 2016. Within the first 5 days of admission, the investigators evaluated the patients’ physical symptom burden using the Edmonton Symptom Assessment System (ESAS). The physical symptoms included fatigue, drowsiness, pain, poor well-being, lack of appetite, insomnia, constipation, dyspnea, and nausea.

Any psychological symptoms were scored using the Patient Health Questionnaire-4 (PHQ-4), which measures anxiety and depression. The investigators then applied separate linear regression models—which were adjusted for age, sex, marital status, education level, time since cancer diagnosis, and cancer type—to assess the relationship between the patients’ symptom burden and their hospital length of stay.

The study included 452 patients (mean age, 61.9 years). Overall, 42% of patients were female, and 55% had hematologic cancers. The median hospital stay was 8.3 days. Using the PHQ-4, 74 (16%) patients had symptoms of depression and 60 (13%) had symptoms of anxiety; the mean ESAS symptom scores were highest for fatigue (6.6), drowsiness (5.4), pain (4.9), and lack of appetite (4.8). Furthermore, multivariable regression analysis confirmed that patients’ physical and psychological symptoms were associated with longer length of stay.

“These data suggest that more needs to be done to alleviate our patients’ symptom burden,” said Dr Johnson. “Palliative care shouldn’t necessarily be limited for patients with incurable disease.”

Given the lack of attention paid to this phenomenon, the investigators are considering additional research into intervention of symptom burden in patients with curable cancer. Dr Johnson cited a current study involving early symptom reporting to the inpatient care team. Although not focused on patients with curable cancer, the objective of the study is to determine the impact of integrating patient-reported symptom data into routine care for hospitalized patients with cancer, he explained.

“If patients with curable gastrointestinal cancer report back high levels of fatigue and drowsiness to the inpatient team, for example, we’d like to find out whether such reporting could drive changes in practice, and whether an intervention would reduce their length of stay,” Dr Johnson concluded.

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Last modified: August 30, 2021