One-Fifth of Hospitalizations for Patients With Gastrointestinal Cancer Considered Avoidable
In a study reported in the Journal of Clinical Oncology, Brooks et al found that oncology clinicians considered 19% of hospitalizations for patients with gastrointestinal cancers to be avoidable.
Study Details
In the study, 201 sequential hospital admissions in 154 patients with gastrointestinal cancer were examined. All patients were followed in the outpatient oncology clinic at Dana-Farber Cancer Institute and were admitted to Brigham and Women’s Hospital with eventual discharge from a medical oncology or inpatient palliative care service. Oncology care providers, including seven medical oncologists and one oncology nurse practitioner, assessed the avoidability of hospitalization by review of electronic medical records.
In the first review stage, two clinicians independently reviewed each hospitalization using a standardized assessment tool; in the second stage, any hospitalization identified as potentially avoidable by at least one reviewer was reexamined by a committee of four clinicians for a final consensus on avoidability. Hospitalization was considered to be not avoidable in any case in which consensus was not reached.
Patients had a median age of 62 years, and colorectal cancer was the most common diagnosis (32%), followed by pancreatic (27%) and esophagogastric cancer (14%); 81% of patients had metastatic cancer. Overall, 53% of hospitalizations were attributed to cancer symptoms and 28% were attributed to complications of cancer treatment. The most common symptomatic reasons for admission were fever/infection (27%), undifferentiated abdominal pain (12%), and gastrointestinal tract obstruction (9%).
Avoidable Hospitalizations and Causes
A total of 39 hospitalizations (19%) were characterized as potentially avoidable. Of these, 85% were identified as preventable—ie, avoidable by different management in the 30 days before hospitalization—and 33% were identified as discretionary—ie, avoidable by outpatient management on the day of hospital admission.
On univariate analysis, factors associated with increased likelihood of potentially avoidable hospitalization were age ≥ 70 years vs < 50 years, three or more hospitalizations over the preceding year, poor performance status, and receipt of oncologist advice to consider hospice, and potentially avoidable hospitalizations were inversely associated with receipt of chemotherapy within 30 days of hospitalization.
On multivariate analysis, factors significantly associated with increased likelihood of potentially avoidable hospitalization were age ≥ 70 years vs < 50 years (odds ratio [OR] = 2.63, P = .021), oncologist advice to consider hospice (OR = 6.09, P < .001), and receipt of three or more lines of palliative chemotherapy (OR = 2.68, P = .047). Risk of death within 90 days was significantly higher in patients with potentially avoidable hospitalization (OR = 6.4, 95% confidence interval = 1.8–22.3).
The investigators concluded, “Potentially avoidable hospitalizations are common in patients with advanced [gastrointestinal] cancer. The majority of potentially avoidable hospitalizations occurred in patients with advanced treatment-refractory cancers near the end of life.”
Gabriel A. Brooks, MD, of Dana-Farber Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Conquer Cancer Foundation of the American Society of Clinical Oncology and a grant from the National Cancer Institute. The study authors reported no potential conflicts of interest.
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