Unplanned Hospitalizations in Patients with Cancer May Lead to Substantial Physical, Psychological Symptoms

A significant number of patients with cancer who are hospitalized unexpectedly experience substantial physical and psychological symptoms, according to study results published in Cancer.

The findings also demonstrated that patients with hematologic cancers and possibly curable solid cancers appear to receive fewer inpatient palliative care consultations.

“Although prior studies have demonstrated disparities in the use of inpatient palliative care among patients with hematologic cancer compared with those with solid cancer, to our knowledge less is known regarding inpatient palliative care use for patients with potentially curable cancer,” the researchers wrote. “A more comprehensive understanding of the palliative and supportive care needs of patients with hematologic cancer and those with potentially curable disease is necessary to ensure that hospitals have adequate and appropriately allocated palliative and supportive care programs.”

The researchers enrolled and surveyed 1,549 patients who were hospitalized with cancer between 2014 and 2017 to compare the symptom burden, palliative care consultation and readmission rates in those patients by cancer type and treatment intent. Among the study participants, 13.6% had potentially curable hematologic cancer, 15.4% had potentially curable solid cancer, 9.7% had incurable hematologic cancer and 61.2% had incurable solid cancer.

Most patients experienced moderate to severe physical symptom burdens including fatigue, poor well‐being, drowsiness, pain and lack of appetite. Compared with other study groups, patients with incurable solid cancer were more likely to have reported moderate to severe pain, lack of appetite, constipation, labored breathing and nausea.

As for psychological symptom burdens, 17.2% of patients reported experiencing depression, 16.6% reported anxiety and 13.1% reported post-traumatic stress disorder. Additionally, patients with incurable solid cancers were more likely to report experiencing anxiety symptoms than any of the other study groups.

Of the total participants, 24.4% received an inpatient palliative care consultation. Patients with incurable solid cancer (28.6%) received the most inpatient palliative care consultations compared with the other study groups. In a separate analysis, patients with incurable solid cancer had a higher likelihood of receiving an inpatient palliative care consultation.

Of the patients at risk for hospital readmission, 13.8% died before being readmitted. A significant percentage of patients across all groups were readmitted to the hospital within 90 days: 42.4% of patients with potentially curable hematologic cancer, 31.2% of potentially curable solid cancer, 40.4% of incurable hematologic cancer and 44.9% of incurable solid cancer.

The results also demonstrated that patients with solid and hematologic incurable cancer experienced a higher risk of hospital readmission or death within 90 days compared with patients with potentially curable solid cancer. Additionally, patients with incurable solid cancer experienced a higher risk of hospital readmission or death compared with patients with incurable hematologic cancer.

“The current study findings highlight the importance of symptom monitoring for hospitalized patients with cancer and have important clinical implications for the allocation of inpatient palliative and supportive care resources,” the researchers wrote.

The development of an inpatient symptom monitoring intervention, according to the researchers, may enhance awareness of patient symptom burden and improve symptom control and health care usage.

“Future studies should test the efficacy of inpatient symptom monitoring as a strategy to address the extensive physical and psychological symptom burdens in hospitalized patients with solid and hematologic cancer regardless of treatment intent,” they concluded.