Symptom burden increases risk of costly hospital readmissions

Hospitalized patients with advanced cancer who report more intense and numerous physical and psychological symptoms appear to be at risk for longer hospital stays and unplanned hospital readmissions, according to a report from Massachusetts General Hospital.

Published online in the journal Cancer, the analysis is one of the first to focus on symptom prevalence and severity among hospitalized patients with cancer, and the first to demonstrate a relationship between uncontrolled symptoms and the use of healthcare services.

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The findings may be of particular interest to providers looking to avoid potential financial penalties levied under the Affordable Care Act, which limit reimbursement for poor showings on measures such as 30-day readmission rates.

Hospitalized patients with advanced cancer tend to experience an immense burden of physical and psychological symptoms, representing potentially modifiable risk factors. The research shows that interventions aimed at improving these symptoms can enhance patient-reported outcomes and potentially tamp down the utilization of healthcare services.

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The study enrolled 1,036 patients with advanced cancer -- defined as those receiving treatment focused on comfort or symptom relief, rather than an attempt to cure their disease -- with unplanned admissions to the MGH from September 2104 through May 2016. Upon admission, participants completed several surveys designed to assess the presence of physical symptoms such as pain, fatigue, drowsiness, nausea, poor appetite and shortness of breath, as well as symptoms of depression and anxiety.

More than half of the participating patients reported currently experiencing moderate to severe fatigue, pain, drowsiness, lack of appetite or poor overall well-being. More than a quarter reported significant levels of depression or anxiety symptoms.

Patients' physical symptoms were significantly associated with longer lengths of stay in the hospital and an increased risk of unplanned readmission within 90 days. Overall psychological distress and depression scores were associated with longer lengths of stay, while patients' anxiety symptoms were associated with higher readmission risk.

Until now, most of the efforts to improve symptom management have focused on ambulatory patients. According to the research, future efforts should focus on the effectiveness of symptom monitoring and supportive care interventions for advanced cancer patients, in an effort to not only improve their symptoms and overall quality of life but to decrease utilizations and readmissions.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com