Location of Discharge Affects Quality of Life and Symptom Burden for Those With Advanced Cancer
Patients with advanced-stage cancer experience frequent hospitalizations, followed by post-discharge transitions of care that can influence patient quality of life. A study presented at the ASCO Annual Meeting (http://abstracts.asco.org/199/AbstView_199_185751.html) sought to examine predictors of discharge location for these patients.
The researchers prospectively enrolled 932 patients with advanced cancer who had unplanned hospitalizations between September 2014 and March 2016. They used the Edmonton Symptom Assessment Scale (ESAS) to assess physical symptoms and the Patient Health Questionnaire (PHQ) to assess psychological symptoms at intake.
They found that most patients (77.9%; n = 726) were discharged home, whereas 12.7% (n = 118) were discharged to post-acute care (PAC; including a skilled nursing facility or long-term acute care hospital), and 9.4% (n = 88) were discharged to hospice.
Compared to patients discharged home, patients discharged to PAC or hospice had higher symptom burden, including dyspnea, constipation, decreased appetite, drowsiness, fatigue, depression, and anxiety (p < 0.05 for all). Patient characteristics of those discharged to PAC or hospice were
- Older age (odds ratio [OR] = 1.03; p < 0.0001)
- Those who lived alone (OR = 1.95; 95% CI = 1.25–3.02; p < 0.003)
- Those who have impaired mobility (OR = 5.08; 95% CI = 3.46–7.45; p < 0.0001)
- Longer length of stay (OR = 1.15; 95% CI, 1.11–1.20; p < 0.0001)
- Higher ESAS physical symptoms (OR = 1.02; 95% CI = 1.003–1.032; p < 0.017)
- Higher PHQ-2 depression symptoms (OR = 1.13; 95% CI = 1.01–1.25; p < 0.027).
Compared to patients discharged to PAC, patients discharged to hospice were more likely to receive palliative care consultation (OR = 4.44. 95% CI = 2.12–9.29; p < 0.0001) and have a shorter length of stay (OR = 0.84; 95% CI = 0.77–0.91, p < 0.0001). Compared to those discharged home, those discharged to PAC had lower survival outcomes (hazard ratio = 1.53; 95% CI = 1.22–1.93; p < 0.0001).
“Patients with advanced cancer discharged to PAC or hospice have substantial physical and psychological symptom burden and poor physical function,” the authors concluded. “They may benefit from targeted interventions to improve their quality of life and care.”