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The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer
Open accessAbstract
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 [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]
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Self-citation
Metadata
- 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
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2017-10-23
- Volume
- 123
- Issue
- 23
- Pages
- 4720-4727
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- 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
- 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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