Symptom Burden Predictive of Hospital Discharge Location

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Mortality is also affected by discharge location, with higher mortality associated with discharge to PAC facility.
Mortality is also affected by discharge location, with higher mortality associated with discharge to PAC facility.
The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage.                        

CHICAGO — Patients with advanced cancer who are discharged to a postacute care (PAC) facility or hospice have substantial physical and psychological symptom burden and poor physical function compared with those who are discharged home, investigators concluded in a presentation at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.

In addition, compared with patients discharged home, those discharged to a PAC facility (skilled nursing facility or long-term acute care hospital) are more likely die.

Daniel E. Lage, a fourth-year medical student at Harvard Medical School in Boston, and colleagues prospectively enrolled 932 patients with advanced cancer with unplanned hospitalizations. Of these 726 (77.9%) were discharged home, 118 (12.7%) were discharged to PAC, and 88 (9.4%) were discharged to hospice. Compared with patients discharged home, those discharged to PAC or hospice had greater symptom burden, including dyspnea, constipation, low appetite, drowsiness, fatigue, depression, and anxiety, Lage and colleagues reported. In addition, patients discharge to PAC or hospice instead of home were significantly more likely to be older (OR 1.03; P <.0001), live alone (OR 1.95, 95% CI, 1.25-3.02; P <.003), have impaired mobility (OR 5.08, 95% CI, 3.46-7.45; P <.0001), longer hospital length of stay (OR 1.15, 95% CI, 1.11-1.20; P <.0001), and higher Patient Health Questionnaire-2 depression symptoms (OR 1.14, 95% CI, 1.01-1.25, P <.027).

In addition, patients discharged to hospital rather than PAC were more likely to receive palliative care consultations (OR 4.44, 95% CI, 2.12-9.29, P <.0001), and have shorter hospital length of stay (OR 0.84, 95% CI, 0.77-0.91, P <.0001).

Compared with patients discharged home, those discharged to hospice had a 53% increased risk of death (HR 1.53, 95% CI, 1.22-1.93, <.0001). 

Read more of Oncology Nurse Advisor's coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

Reference

Lage DE, Nipp RD, D'Arpino S, et al. Post-discharge transitions of care for hospitalized patients with advanced cancer. Oral presentation at: 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL.


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