Hospitalized Patients with Cancer May Face More Physical and Psychological Symptoms

According to a study published in Cancer, patients with cancer who are hospitalized experience substantial physical and psychological symptoms. 

Moreover, palliative care is rarely consulted for highly symptomatic patients with possibly curable cancer. Supportive care interventions should therefore target the needs of symptomatic patients, regardless of the treatment intent.

“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 authors wrote. 

In this single-center study of hospitalized patients with cancer between 2014 and 2017, researchers evaluated physical symptoms using the Edmonton Symptom Assessment System and psychological distress using the Patient Health Questionnaire-4 and the Primary Care PTSD Screen. Further, multivariate linear regression models were used to assess symptom burden, logistic regression was used to evaluate palliative care use, and competing risk regression was used to compare 90-day readmission risk. 

Of the total of 1,549 patients enrolled and surveyed, the majority of patients reported moderate to severe fatigue, poor well-being, and drowsiness with no significant differences seen by cancer type and treatment intent. Compared to other groups, patients who had incurable solid cancer reported higher physical symptoms (beta coefficient [B], 4.73; P < 0.01) and symptoms of depression (B, 0.44; P < 0.01) and anxiety (B, 0.39; P < 0.01), but no difference in posttraumatic stress disorder.

Among the patients in the top quartile symptom burden according to the Edmonton Symptom Assessment System, palliative care service was consulted in 14.7%, 7.9%, 25.0%, and 49.6%, respectively, of patients with potentially curable hematologic, potentially curable solid, incurable hematologic, and incurable solid cancer (P< 0.001). Additionally, compared with patients who had potentially curable solid cancer, patients in each group experienced a higher risk of readmission within 90 days. 

“This finding may reflect unmeasured differences in disease trajectory and unique physical illness manifestations of advanced solid cancers,” the authors wrote. “Nonetheless, the current study findings underscore the need for adequate supportive care services for all hospitalized patients with cancer. This is particularly relevant for patients with curable illness and hematologic cancer, whose physical and psychological symptom burdens may be underappreciated.”

The data presented indicate that patients’ symptoms may be underrecognized in the inpatient setting regardless of cancer type or treatment intent. Targeting palliative care resources, however, to meet the needs of the most symptomatic patients could prove to be an effective strategy through which to address the immense symptom burden of all hospitalized patients with cancer.

“The current study data have highlighted the need to focus on the appropriate allocation of supportive and palliative care resources to meet the palliative care needs of the oncology population,” the authors wrote. “Future symptom monitoring interventions are needed to identify high-risk patients regardless of cancer type and treatment intent and to personalize early supportive care interventions.”

The researchers indicated that future studies within this area are necessary, including studies testing 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. Additionally, future studies should test innovative models of care such as an oncology-palliative care co-rounding system to supply the highest quality care to the most symptomatic hospitalized patients with cancer. 

Reference:

Newcomb RA, Nipp RD, Waldman LP, et al. Symptom Burden in Patients With Cancer Who Are Experiencing Unplanned Hospitalization. Cancer. doi:10.1002/cncr.32833.