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
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.
Cancer. 2017 Dec 1;123(23):4720-4727. doi: 10.1002/cncr.30912. Epub 2017 Oct 23.
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.
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.
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.
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.
晚期癌症患者经常经历频繁且持续时间长的住院治疗；然而，与更高医疗保健利用率相关的因素尚未得到描述。我们试图研究患者的身体和心理症状负担与医疗保健利用率之间的关系。
我们纳入了2014年9月至2016年5月期间患有晚期癌症且有非计划住院治疗的患者。入院时，我们评估了身体症状（埃德蒙顿症状评估系统[ESAS]）和心理症状（患者健康问卷4[PHQ-4]）。我们使用线性回归分析住院时间（LOS），并使用Cox回归分析90天内首次非计划再入院时间，以此来研究症状负担与医疗保健利用率之间的关系。我们对所有模型进行了年龄、性别、婚姻状况、合并症、教育程度、晚期癌症诊断后的时间以及癌症类型的调整。
我们纳入了连续接触的1152名患者中的1036名（89.9%）。超过一半的患者报告有中度/重度疲劳、幸福感差、嗜睡、疼痛和食欲不振。PHQ-4评分显示，分别有28.8%和28.0%的患者有抑郁和焦虑症状。平均住院时间为6.3天，90天再入院率为43.1%。身体症状（ESAS：未标准化系数[B]，0.06；P<.001）、心理困扰（PHQ-4总分：B，0.11；P =.040）和抑郁症状（PHQ-4抑郁：B，0.22；P =.017）与更长的住院时间相关。身体症状（ESAS：风险比，1.01；P<.001）和焦虑症状（PHQ-4焦虑：风险比，1.06；P =.045）与再入院的可能性更高相关。
住院的晚期癌症患者症状负担较重，这与住院时间延长和再入院显著相关。需要采取干预措施来解决该人群的症状负担，以改善医疗保健的提供和利用。《癌症》2017年；123:4720 - 4727。©2017美国癌症协会。
