The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

Nipp, Ryan D.; El‐Jawahri, 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.

doi:10.1002/cncr.30912

Cited by 230Palliative Care and End-of-Life IssuesPalliative and Oncologic CareCancer survivorship and care

The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

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Nipp, Ryan D., El‐Jawahri, Areej, Moran, Samantha M., D'Arpino, Sara M., Johnson, P. Connor, Lage, Daniel E., Wong, Risa L., Pirl, William F. +8 more·2017·Cancer

DOI 10.1002/cncr.30912PMC PMC5746191

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Abstract

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.

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Distress in cancer patients has been associated with non-adherence to anti-cancer medications; increased number of clinic and emergency room visits, longer hospital stays; worse quality of life and inferior survival.
“Distress in cancer patients has been associated with non-adherence to anti-cancer medications; increased number of clinic and emergency room visits, longer hospital stays [55, 56]; worse quality of life and inferior survival [57–59].”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [56]
The Results (The Relationship between Symptom Burden and Hospital Length of Stay; page unavailable) associate psychological distress and depression symptoms with longer hospital stays in hospitalized patients with advanced cancer. The paper measures hospital length of stay and readmissions, not clinic or emergency-room visits, so it does not support that part of the claim. The other outcomes in the sentence are not attached to this citation. (LLM, conf=0.88)
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“Distress in cancer patients has been associated with nonadherence to anti-cancer medications; increased number of clinic and emergency room visits, longer hospital stays [55, 56]; worse quality of life and inferior survival [57–59].”
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Parallel Journeys of Patients with Cancer and Depression: Challenges and Opportunities for Technology-Enabled Collaborative Care
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Psychological Symptoms in Advanced Cancer
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Effect of a Symptom Monitoring Intervention for Patients Hospitalized With Advanced Cancer
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Association of a Lay Health Worker Intervention With Symptom Burden, Survival, Health Care Use, and Total Costs Among Medicare Enrollees With Cancer
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Cost‐effectiveness of the Collaborative Care to Preserve Performance in Cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers
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“Other 1 (5) 2 (10) 3 (15) 0 (0) Household income US$, n (%)a 0.”
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Effect of exercise interventions on hospital length of stay and admissions during cancer treatment: a systematic review and meta-analysis
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Increased Length of Stay Associated With Antibiotic Use in Older Adults With Advanced Cancer Transitioned to Comfort Measures
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Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding, Treatment Preferences, and Advance Care Planning
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Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer
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Evaluation of PROMIS Preference Scoring System (PROPr) in Patients Undergoing Hemodialysis or Kidney Transplant
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Thirty-Day Readmissions in Patients With Metastatic Cancer: Room for Improvement?
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Protocol for the development and validation of a measure of persistent psychological and emotional distress in cardiac patients: the Cardiac Distress Inventory
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Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits
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Network analysis used to investigate the interplay among somatic and psychological symptoms in patients with cancer and cancer survivors: a scoping review
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Supportive oncology care at home interventions: protocols for clinical trials to shift the paradigm of care for patients with cancer
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Integration of Specialist Palliative Care into Tertiary Hospitals: A Multicenter Point Prevalence Survey from Thailand
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Association of Social Support With Overall Survival and Healthcare Utilization in Patients With Aggressive Hematologic Malignancies
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Short and long-term barriers and facilitators of skin self-examination among individuals diagnosed with melanoma
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Matching-Adjusted Indirect Comparison of Health-Related Quality of Life and Adverse Events of Apalutamide Versus Enzalutamide in Non-Metastatic Castration-Resistant Prostate Cancer
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Associations of Skeletal Muscle With Symptom Burden and Clinical Outcomes in Hospitalized Patients With Advanced Cancer
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Perioperative Trends in Distress Among Cancer Patients: A Systematic Review and Meta‐Analysis
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Cognitive‐behavioral and mindfulness‐based interventions for distress in patients with advanced cancer: A meta‐analysis
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Breast cancer patients’ needs and perspectives on a one-on-one peer support program: quantitative and qualitative analyses
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Association Between Music Therapy Techniques and Patient-Reported Moderate to Severe Fatigue in Hospitalized Adults With Cancer
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Harnessing the Power of Patient-Reported Outcomes in Oncology
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Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
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Effectiveness of symptom monitoring on electronic patient-reported outcomes (ePROs) among patients with lung cancer: a systematic review and meta-analysis
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Is it the time to implement the routine use of distress thermometer among Egyptian patients with newly diagnosed cancer?
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Early palliative intervention: effects on patient care satisfaction in advanced cancer
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Factors Related to Family Caregivers’ Readiness for the Hospital Discharge of Advanced Cancer Patients
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Trajectories of Health-related quality of life in patients with Advanced Cancer during the Last Year of Life: findings from the COMPASS study
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Association of Remote Patient-Reported Outcomes and Step Counts With Hospitalization or Death Among Patients With Advanced Cancer Undergoing Chemotherapy: Secondary Analysis of the PROStep Randomized Trial
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Text Messaging in Cancer-Supportive Care: A Systematic Review
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Mindfulness Affects the Level of Psychological Distress in Patients With Lung Cancer via Illness Perception and Perceived Stress: A Cross-Sectional Survey Study
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Efficacy and mechanisms of 4-week MBSR on psychological distress in lung cancer patients: A single-center, single-blind, longitudinal, randomized controlled trial
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The caring experiences of family caregivers for patients with advanced cancer in Uganda: A qualitative study
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Supportive Oncology Care at Home Intervention for Patients With Pancreatic Cancer
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Associations of baseline patient‐reported outcomes with treatment outcomes in advanced gastrointestinal cancer
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Prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy: A cross-sectional study
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Palliative Care: Oncology Nurses’ Confidence in Provision to Patients With Cancer
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Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study
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Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes
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Comparison of Depressive Symptom Outcomes in Hospitalized Adult Cancer Patients Receiving Music Therapy or Massage Therapy
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Trends in Hospital Admissions Due to Neoplasms in England and Wales between 1999 and 2019: An Ecological Study
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Remote Patient-Reported Outcomes and Activity Monitoring to Improve Patient-Clinician Communication Regarding Symptoms and Functional Status: A Randomized Controlled Trial
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Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer
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Perspectives of Health Care Payer Organizations on Cancer Care Delivery Redesign: A National Study
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Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial
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Responding to distress in cancer care: Increasing access to psycho oncology services through integrated collaborative care
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Psychosocial distress and associated factors among adult cancer patients at oncology: a case of Ethiopia
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Addressing Educational Needs in Managing Complex Pain in Cancer Populations: Evaluation of APAM: An Online Educational Intervention for Nurses
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Patient Reported Outcomes and Unscheduled Health Services use During Oral Anti-Cancer Treatment
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Mental Adjustment, Functional Status, and Depression in Advanced Cancer Patients
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Physical symptom burden in patients with desmoid‐type fibromatosis and its impact on health‐related quality of life and healthcare use
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Authors: Nipp, R. D., El‐Jawahri, A., Moran, S. M., D'Arpino, S. M., Johnson, P. C., Lage, D. E., Wong, R. L., Pirl, W. F., Traeger, L., Lennes, I. T., Cashavelly, B. J., Jackson, V. A., Greer, J. A., Ryan, D. P., Hochberg, E. P., & Temel, J. S.
Affiliations: Harvard University (US)
Department of Medicine, Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston Massachusetts
Department of Psychiatry Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
University of Miami (US)
Corresponding author: Nipp, Ryan D.
ORCID: Nipp, Ryan D.
El‐Jawahri, Areej
Johnson, P. Connor
Lage, Daniel E.
Wong, Risa L.
Pirl, William F.
Traeger, Lara
Lennes, Inga T.
Jackson, Vicki A.
Greer, Joseph A.
Ryan, David P.
Hochberg, Ephraim P.
Temel, Jennifer S.
Venue: Cancer
Publisher: Wiley
Published: 2017-10-23
Volume: 123
Issue: 23
Pages: 4720-4727
ISSN: 0008-543X (ISSN-L)
1097-0142
DOI: 10.1002/cncr.30912
PMC: PMC5746191
OpenAlex: W2765843352
Cited by: 230
References: 49
Citations by year: 2026: 11 · 2025: 23 · 2024: 29 · 2023: 27 · 2022: 51 · 2021: 33 · 2020: 20 · 2019: 21 · 2018: 14
FWCI: 14.12
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Cancer (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Cancer Institute (K24 CA181253)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: advanced cancer, symptom burden, somatic symptoms, psychological distress, depression, anxiety, health care utilization, length of hospital stay, unplanned hospital readmission, hospitalized cancer patients, fatigue, pain, sleepiness, appetite loss
MeSH terms: Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Neoplasms, Palliative Care, Patient Acceptance of Health Care, Prognosis, Psychometrics, Severity of Illness Index

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The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

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