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. 2018 Jan 1;36(1):76-82.
doi: 10.1200/JCO.2017.74.0340. Epub 2017 Oct 25.

Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer

Daniel E Lage  1 , Ryan D Nipp  1 , Sara M D'Arpino  1 , Samantha M Moran  1 , P Connor Johnson  1 , Risa L Wong  1 , William F Pirl  1 , Ephraim P Hochberg  1 , Lara N Traeger  1 , Vicki A Jackson  1 , Barbara J Cashavelly  1 , Holly S Martinson  1 , Joseph A Greer  1 , David P Ryan  1 , Jennifer S Temel  1 , Areej El-Jawahri  1
Affiliations

Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer

Daniel E Lage et al. J Clin Oncol. .

Abstract

Purpose Patients with advanced cancer experience potentially burdensome transitions of care after hospitalizations. We examined predictors of discharge location and assessed the relationship between discharge location and survival in this population. Methods We conducted a prospective study of 932 patients with advanced cancer who experienced an unplanned hospitalization between September 2014 and March 2016. Upon admission, we assessed patients' physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4). The primary outcome was discharge location (home without hospice, postacute care [PAC], or hospice [any setting]). The secondary outcome was survival. Results Of 932 patients, 726 (77.9%) were discharged home without hospice, 118 (12.7%) were discharged to PAC, and 88 (9.4%) to hospice. Those discharged to PAC and hospice reported high rates of severe symptoms, including dyspnea, constipation, low appetite, fatigue, depression, and anxiety. Using logistic regression, patients discharged to PAC or hospice versus home without hospice were more likely to be older (odds ratio [OR], 1.03; 95% CI, 1.02 to 1.05; P < .001), live alone (OR, 1.95; 95% CI, 1.25 to 3.02; P < .003), have impaired mobility (OR, 5.08; 95% CI, 3.46 to 7.45; P < .001), longer hospital stays (OR, 1.15; 95% CI, 1.11 to 1.20; P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR, 1.02; 95% CI, 1.003 to 1.032; P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR, 1.13; 95% CI, 1.01 to 1.25; P < .027). Patients discharged to hospice rather than PAC were more likely to receive palliative care consultation (OR, 4.44; 95% CI, 2.12 to 9.29; P < .001) and have shorter hospital stays (OR, 0.84; 95% CI, 0.77 to 0.91; P < .001). Patients discharged to PAC versus home had lower survival (hazard ratio, 1.53; 95% CI, 1.22 to 1.93; P < .001). Conclusion Patients with advanced cancer who were discharged to PAC facilities and hospice had substantial physical and psychological symptom burden, impaired physical function, and inferior survival compared with those discharged to home. These patients may benefit from interventions to enhance their quality of life and care.

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Figures

Fig 1.
Fig 1.
Participants’ symptom severity by discharge location. Only statistically significant P values are shown.
Fig 2.
Fig 2.
Overall survival by discharge location.
Fig A1.
Fig A1.
Participant flow diagram.
See this image and copyright information in PMC

References

    1. Institute of Medicine: Dying in America. Washington, DC, The National Academies Press, 2015.
    1. Gozalo P, Teno JM, Mitchell SL, et al. : End-of-life transitions among nursing home residents with cognitive issues. N Engl J Med 365:1212-1221, 2011 - PMC - PubMed
    1. Teno JM, Gozalo PL, Bynum JPW, et al. : Change in end-of-life care for Medicare beneficiaries: Site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA 309:470-477, 2013 - PMC - PubMed
    1. Wright AA, Zhang B, Ray A, et al. : Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665-1673, 2008 - PMC - PubMed
    1. Wright AA, Keating NL, Balboni TA, et al. : Place of death: Correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol 28:4457-4464, 2010 - PMC - PubMed

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