Hospitalizations in Advanced Cancer: What Makes Patients Stay or Come Back

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In addition to physical symptoms, psychological distress and depression factored into longer hospital stays, investigators found.
In addition to physical symptoms, psychological distress and depression factored into longer hospital stays, investigators found.

Patients with advanced cancer experience prolonged hospital stays and have higher risk for readmissions due to high physical and psychological symptom burden, a study published in Cancer has shown.

Recent studies show that the utilization of healthcare resources by patients with advanced cancer is increasing, but the factors associated with this increase have not been fully explored.

Investigators enrolled 1036 patients with advanced cancer and unplanned hospitalizations to evaluate the relationship between patients' self-reported symptom burden and healthcare utilization. Physical symptoms were measured by the Edmonton Symptom Assessment System (ESAS), and psychological symptoms were measured using the Patient Health Questionnaire 4 (PHQ-4).

More than 50% of patients reported having moderate/severe fatigue, drowsiness, poor well-being, lack of appetite, and pain. Analysis of PHQ-4 scores revealed that 28.8% of patients experienced depression and 28.0% experienced symptoms of anxiety.

The 90-day readmission rate was 43.1%, and the mean length of stay at the hospital was 6.3 days.

Factors associated with prolonged hospital stay were physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P <.001), psychological distress (PHQ-4 total: B, 0.22; P =.040), and depression symptoms (PHQ-4 depression: B, 0.22; P =.17).

Factors associated with a greater likelihood for readmission were physical symptoms (ESAS: hazard ratio [HR], 1.01; P <.001), and anxiety symptoms (PHQ-4: HR, 1.06; P =.045).

The authors concluded that “[t]hese findings highlight the critical need to monitor and address the physical and psychological symptom burden of hospitalized patients with advanced cancer. Interventions to identify and treat symptomatic patients hold great potential for improving patients' experience with their illness, enhancing their quality of life, and reducing their health care utilization.”


Nipp RD, El-Jawahri A, Moran SM, et al. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced care [published online October 23, 2017]. Cancer. doi: 10.1002/cncr.30912 

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