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The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer
Author(s) -
Nipp Ryan D.,
ElJawahri Areej,
Moran Samantha M.,
D'Arpino Sara M.,
Johnson P. Connor,
Lage Daniel E.,
Wong Risa L.,
Pirl William F.,
Traeger Lara,
Lennes Inga T.,
Cashavelly Barbara J.,
Jackson Vicki A.,
Greer Joseph A.,
Ryan David P.,
Hochberg Ephraim P.,
Temel Jennifer S.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30912
Subject(s) - medicine , anxiety , patient health questionnaire , depression (economics) , hazard ratio , comorbidity , marital status , cancer , proportional hazards model , physical therapy , psychiatry , confidence interval , population , depressive symptoms , economics , macroeconomics , environmental health
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 .