Hospitalization and Rehospitalization After Diagnosis of Advanced Cancer

Key Points

  • A total of 71% of patients with advanced cancer were hospitalized in the year after diagnosis, and 16% had at least three hospitalizations.
  • Rehospitalization was less likely after discharge from a hospital with an outpatient palliative care program than from a for-profit hospital.

In a study reported in the Journal of Clinical Oncology, Whitney et al found that the majority of patients diagnosed with advanced cancer were hospitalized within 1 year of diagnosis, with a sizable proportion having multiple hospitalizations.

Hospitalization Rates

The study involved California Cancer Registry data from 25,032 patients diagnosed with advanced breast, colorectal, non–small cell lung (NSCLC), or pancreatic cancer between 2009 and 2012.

In the year after diagnosis, 71% of patients with advanced cancer were hospitalized and 16% had three or more hospitalizations, with 64% of hospitalizations originating in the emergency department. Hospitalization rates were highest for colorectal cancer (79.5%) and pancreatic cancer (74.0%). Overall, 53% of all patients died within the first year after diagnosis.

Factors in Rehospitalization

Rehospitalization was associated with black (incidence rate ratio [IRR] = 1.29, 95% confidence interval [CI] = 1.17–1.42) and Hispanic (IRR = 1.11, 95% CI = 1.03–1.20) vs white race/ethnicity; public insurance (IRR = 1.37, 95% CI = 1.23–1.47) and no insurance (IRR = 1.17, 95% CI = 1.02–1.35) vs private insurance; lower vs highest socioeconomic status quintiles (IRR = 1.09–1.29); one (IRR = 1.13, 95% CI = 1.04–1.23) and two (IRR =1.59, 95% CI = 1.47–1.73) vs no comorbidities; and pancreatic cancer (IRR = 2.07, 95% CI = 1.95–2.20) and NSCLC (IRR = 1.69, 95% CI = 1.54–1.86) vs colorectal cancer.

Rehospitalization was less common after discharge from a hospital with an outpatient palliative care program (IRR = 0.90, 95% CI = 0.83–0.97) and more common after discharge from a for-profit hospital (IRR = 1.33, 95% CI = 1.14–1.56).

The investigators concluded: “Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.”

The study was supported by the Gordon and Betty Moore Foundation, Jonas Center for Nursing and Veteran’s Healthcare, and the Oncology Nursing Society.

Robin L. Whitney, PhD, of the University of California, San Francisco-Fresno, is the corresponding author of the Journal of Clinical Oncology article.

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®.