In a single-institution cohort study reported in JAMA Network Open, Chang et al identified patterns of symptoms preceding unplanned acute care encounters for patients with cancer.
Study Details
The study involved data from all unplanned acute care encounters (emergency department visits and hospitalizations) among patients with a primary cancer diagnosis at University of California, San Francisco between January 2013 and December 2023. Symptoms documented within the 30 days prior to encounters were identified.
Key Findings
A total of 28,708 patients with cancer included in the analysis had 70,606 acute care encounters and a total of 854,830 documented symptoms prior to the encounters. Patients had a median age of 61 years (interquartile range = 48–70 years). Men (37,861 encounters, 53.62%) and White patients (39,989 encounters, 56.64%) accounted for most encounters.
Among documented symptoms, pain (7.54%), nausea (6.74%), vomiting (5.79%), fatigue (5.26%), constipation (3.93%), fever (3.39%), generalized muscle weakness (3.32%), extremity edema (3.28%), dyspnea (3.12%), and headache (2.92%) were the most common.
On multivariate analysis, high symptom burden (> 10 unique symptoms prior to acute care) was more likely among female patients (adjusted odds ratio [aOR] = 1.14, 95% confidence interval [CI] = 1.10–1.18, P < .001), Asian patients (aOR = 1.22, 95% CI = 1.17–1.28, P < .001), Black patients (aOR = 1.17, 95% CI = 1.10–1.25, P < .001), American Indian or Alaska Native patients (aOR = 1.21, 95% CI = 1.01–1.44, P = .04), and Medicaid-insured patients (aOR= 1.10, 95% CI = 1.05–1.14, P < .001).
High symptom burden documented prior to acute encounters was less likely among patients aged ≥ 65 years (aOR = 0.96, 95% CI = 0.92–1.00, P = .04) and uninsured patients (aOR = 0.58, 95% CI = 0.45–0.76, P < .001).
The investigators concluded: “The findings of this study highlight common symptoms preceding acute care as well as the need for further research on interventions to reduce patient burden, improve quality of life, and reduce the use of acute care in patients with cancer.”
Julian C. Hong, MD, MS, of the University of California, San Francisco, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by the National Cancer Institute, a Conquer Cancer Career Development Award, and others. For full disclosures of the study authors, visit jamanetwork.com.
