Predictors of Posthospital Care Transitions in Advanced Cancer

Key Points

  • Patients discharged to post–acute care facilities or hospice reported high rates of severe symptoms vs those discharged home without hospice.
  • Significant predictors of discharge to a post–acute care facility or hospice vs home included older age, living alone, impaired mobility, higher physical symptom score, and higher depression score.

In a study reported in the Journal of Clinical Oncology, Lage and colleagues found that among patients with advanced cancer who had an unplanned hospital admission, those discharged to hospice or post–acute care facilities had a worse symptom burden and physical function and worse survival than did those discharged home without hospice.

Study Details

The prospective study included 932 patients with advanced cancer (those not being treated with curative intent) who had an unplanned admission to Massachusetts General Hospital between September 2014 and March 2016. Upon admission, patients’ physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4) were assessed. The primary outcome was discharge location, consisting of home without hospice, post–acute care facility, or hospice in any setting.

Factors in Discharge Location

Of the 932 patients, 726 (77.9%) were discharged home without hospice; 118 (12.7%), to a post–acute care facility; and 88 (9.4%), to hospice. Compared with patients discharged home without hospice, those discharged to a post–acute care facility and to hospice reported high rates of severe symptoms, including dyspnea (19% vs 28% and 34%, P < .001), constipation (24% vs 31% and 36%, P < .017), low appetite (41% vs 56% and 60%, P < .001), fatigue (60% vs 70% and 72%, P < .013), depression (25% vs 42% and 49%, P < .001), and anxiety (24% vs 38% and 38%, P < .003).

On regression analysis, patients discharged to a post–acute care facility or hospice vs home without hospice were more likely to be older (odds ratio [OR] = 1.03, P < .001), live alone (OR = 1.95, P < .003), have impaired mobility (OR = 5.08, P < .001), longer hospital stays (OR = 1.15, P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR = 1.02, P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR = 1.13, P < .027). Patients discharged to hospice vs a post–acute care facility were more likely to receive palliative care consultation (OR = 4.44, P < .001) and have shorter hospital stays (OR = 0.84, P < .001). Patients discharged to a post–acute care facility vs home without hospice had poorer survival (hazard ratio = 1.53, P < .001).

The investigators concluded: “Patients with advanced cancer who were discharged to [post–acute care] 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.”

The study was supported by the Scullen Family Center for Cancer Data Analysis, Conquer Cancer Foundation, Ghiso Fellowship in Compassionate Care, and a grant from the National Institutes of Health.

Areej El-Jawahri, MD, of Massachusetts General Hospital Cancer Center, is the corresponding author of the Journal of Clinical Oncology article. Daniel E. Lage, MD, and Ryan D. Nipp, MD, MPH, contributed equally to the work.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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