Depression, fatigue tied to more hospital stays for terminal cancer

 

Patients with advanced cancer may spend more time in the hospital when they have untreated symptoms like fatigue and depression, a recent study suggests.

The study focused on 1,036 advanced cancer patients who had unplanned hospital stays. More than half of them had moderate or severe fatigue, poor wellbeing, drowsiness, pain and lack of appetite, and more than one in four had depression or anxiety.

Overall, these unplanned hospitalizations lasted an average of 6.3 days, but stays were longer when patients were depressed. Within 90 days of being sent home, 43 percent of the patients were hospitalized again; repeat hospitalizations were more common among people with anxiety.

Efforts to alleviate patients’ symptom burden “hold great promise for improving patients’ experience with their illness, enhancing their quality of life, and reducing their health care utilization,” said lead study author Dr Ryan Nipp, a researcher at Massachusetts General Hospital and Harvard Medical School in Boston.

The findings can help clinicians and policymakers assess the extent to which uncontrolled symptoms contribute to excessive and costly cancer care, Nipp said by email.

Although many terminal cancer patients would prefer to remain at home, more than half of them are admitted to the hospital at least once during their last month of life, and 10 percent are hospitalized at least twice during this time, researchers note in the journal Cancer.

None of the patients in the current study were receiving treatment designed to cure their tumors.

Within 90 days of being admitted to the hospital, 42 percent of the patients died. The odds of death were higher for patients who reported being depressed or suffering physical and psychological problems.

The study was done at a single medical center, and most of the patients were white, married and educated beyond high school. The results might be different for a more diverse group of patients, the authors note.

And while the research showed a link between uncontrolled physical and mental health problems and more hospital time, the study wasn’t a controlled experiment designed to prove whether or how these untreated issues might increase use of health services, the researchers also point out.

Even so, the study adds to evidence that these untreated symptoms may lead to avoidable treatments that may drive up health care costs, said Dr. Preeti Malani, a researcher at the University of Michigan in Ann Arbor who wasn’t involved in the study.

“From an overall perspective, every day that an individual with advanced cancer is in the hospital, that’s a day he or she isn’t home, so this is also an important quality of life issue,” Malani said by email.

Part of the problem may be that patients don’t know about their options for palliative care that focuses on comfort rather than a cure, or they lack access to these services, Malani added.

“Improved access to palliative care would be helpful for symptom management as well as avoiding hospitalizations and aggressive treatment that doesn’t provide benefits,” Malani noted. Care teams need to make palliative care part of routine care, she said.

Part of the problem may be helping patients transition from aggressive treatment to comfort care, said Dio Kavalieratos, a researcher at the Palliative and Supportive Institute at the University of Pittsburgh Medical Center who wasn’t involved in the study.

“It intuitively makes sense that if a patient’s symptoms are under control, that is one (more) reason that they would be able to stay comfortably at home instead of in the hospital,” Kavalieratos said by email. “Unfortunately, most cancer therapy is so focused on treating the cancer itself, that concerns like symptoms, emotional well being, and quality of life sometimes aren’t the top priority.”