Outcomes Best With Discharge to Home vs PAC or Hospice in Advanced Cancer

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Patient in a palliative care unit.
Patient in a palliative care unit.

Patients with advanced cancer who are discharged to postacute care (PAC) or hospice experience poorer survival outcomes and more physical and psychological burdens compared with those who are discharged to home, a study published in the Journal of Clinical Oncology has shown.

Researchers conducted a prospective study involving 932 patients with advanced cancer who were unexpectedly hospitalized. On hospitalization, patients' physical symptoms and psychological distress were evaluated using the Edmonton Symptom Assessment System-Revised (ESAS-r) and Patient Health Questionnaire-4 (PHQ-4), respectively.

The primary end point was an assessment of where patients were discharged to: home, PAC, or hospice. Secondary outcome was survival.


Analysis of the data showed that nearly 78% of patients were discharged to home without hospice, 12.7% were discharged to PAC, and 9.4% to hospice.

Patients who were discharged to PAC experienced high rates of psychological and physical burden, including dyspnea, constipation, low appetite, fatigue, depression, and anxiety. Patients discharged to PAC or hospice vs home without hospice were more likely to live alone (odds ratio [OR], 1.95; 95% CI, 1.25-3.02; P <.003), older age (OR, 1.03; 95% CI, 1.02-1.05; P <.001), impaired mobility (OR, 5.08; 95% CI, 3.46-7.45; P <.001), longer hospital stay (OR, 1.15; 95% CI, 1.11-1.20; P <.001), higher PHQ-4 scores (OR, 1.13; 95% CI, 1.01-1.25; P <.027), and higher ESAS-r scores (OR, 1.02; 95% CI, 1.003-1.032; P <.017).


Patients discharged to hospice care vs PAC were likely to receive palliative care consultations (OR, 4.44; 95% CI, 2.12-9.29; P <.001) and have shorter hospital length of stay (OR, 0.84; 95% CI, 0.77-0.91; P <.001). Survival was lower in patients discharged to PAC vs those discharged to home (hazard ratio [HR], 1.53; 95% CI, 1.22=1.93; P <.001).

The authors noted that patients discharged to PAC or hospice care had similar ESAS-r and PHQ-4 scores as patients discharged to home without hospice, but accommodations needed to experience improvements in quality of life were unavailable at these facilities. The authors concluded that “[f]uture research should focus on developing targeted interventions to address the functional, social, and symptomatic needs of this population.”

Reference

Lage DE, Nipp RD, D'Arpino SM, et al. Predictors of posthospital transitions of care in patients with advanced cancer [published online October 25, 2017]. J Clin Oncol. doi: 10.1200/JCO.2017.74.0340
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