Palliative Care 2016: Rehospitalization of Patients With Advanced Cancer in the Year After Diagnosis

Key Points

  • Rehospitalization rates were significantly higher for black non-Hispanics, Hispanics, or Asian/Pacific Islanders vs white non-Hispanics.
  • Rates were also higher for public insurance or no insurance vs private insurance, and for lower socioeconomic status quintiles vs the highest.
  • Increased rates were also present in the cases of 1, 2, or more comorbidities vs no comorbidities, and for pancreatic cancer and NSCLC vs colorectal cancer.

Among individuals with advanced cancer, frequent hospitalization is often at odds with patient preference and is increasingly viewed as a hallmark of poor quality care. Hospitalization contributes substantially to costs and regional spending variation in this population, but patterns and reasons are poorly described in the literature. California Cancer Registry data linked with hospital claims were used to quantify hospitalization in the year after diagnosis among individuals with advanced cancer. These findings were presented by Whitney et al at the 2016 Palliative Care in Oncology Symposium (Abstract 10).

Study Methods

Researchers led by Robin L. Whitney, of the Betty Irene Moore School of Nursing at the University of California, Davis, examined California Cancer Registry data relating to hospitalization in colorectal, pancreatic, prostate, breast, and non–small cell lung cancers (NSCLC) between 2009 and 2012 (N = 25,032). Multistate models and multilevel log-linear Poisson regression were used to model rehospitalizations as a function of individual and hospital characteristics, accounting for the competing risk of mortality.

Key Results

Among individuals with advanced cancer, 71% were hospitalized; 16% had at least 3 hospitalizations; and 64% of hospitalizations originated in the emergency department.

Rehospitalization rates were significantly higher for black non-Hispanics (incident rate ratio [IRR] = 1.3; 95% confidence interval [CI] = 1.1–1.4); Hispanics (IRR = 1.1; 95% CI = 1.0–1.2); or Asian/Pacific Islanders (IRR = 1.1; 95% CI = 1.0–1.2) vs white non-Hispanics.

Rates were also higher for public (IRR = 1.4; 95% CI = 1.3–1.5) or no insurance (IRR = 1.2; 95% CI = 1.0–1.5) vs private insurance; and for lower socioeconomic status quintiles (IRRs = 1.1­–1.3) vs the highest.

Increased rates were also present in the cases of 1, 2, or more (IRR = 1.1­–1.6) comorbidities vs no comorbidities, and for pancreatic cancer (IRR = 2.1; 95% CI = 1.9–2.2) and NSCLC (IRR = 1.7; 95% CI = 1.5–1.9) vs colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital reporting an outpatient palliative care program (IRR = 0.90; 95% CI = 0.84–0.96).

Conclusions

Individuals with advanced cancer experience a heavy burden of hospitalizations, many of which originate in the emergency department. Discharge from a hospital reporting an outpatient palliative care program appears to protect against rehospitalization. Efforts to reduce hospitalization and provide care congruent with patient preferences might focus on improving access to outpatient palliative care, particularly among subgroups at greater risk, including racial/ethnic minority groups, and those with a lower socioeconomic status, comorbidities, and/or pancreatic cancer or NSCLC.

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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