Association between symptoms and their severity with survival time in hospitalized patients with far advanced cancer

2011 ◽  
Vol 25 (7) ◽  
pp. 682-690 ◽  
Author(s):  
Yong Liu ◽  
Qing-song Xi ◽  
Shu Xia ◽  
Liang Zhuang ◽  
Wei Zheng ◽  
...  
Keyword(s):  
Survival Time ◽  
Advanced Cancer ◽  
Hospitalized Patients

“The surprise questions” using variable time frames in hospitalized patients with advanced cancer

2021 ◽  
pp. 1-5
Author(s):  
Sun Hyun Kim ◽  
Sang-Yeon Suh ◽  
Seok Joon Yoon ◽  
Jeanno Park ◽  
Yu Jung Kim ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Time Frame ◽  
Hospitalized Patients ◽  
Advanced Cancer Patients ◽  
Multicenter Cohort Study ◽  
Prediction Of Survival ◽  
Sensitivity Specificity ◽  
Surprise Question ◽  
Time Frames

Abstract Objective Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs). Method This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival. Results We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively. Significance of results Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.

Distress Due to Prognostic Uncertainty in Palliative Care: Frequency, Distribution, and Outcomes among Hospitalized Patients with Advanced Cancer

2018 ◽  
Vol 21 (3) ◽  
pp. 315-321 ◽  
Author(s):  
Robert Gramling ◽  
Susan Stanek ◽  
Paul K.J. Han ◽  
Paul Duberstein ◽  
Tim E. Quill ◽  
...  
Keyword(s):  
Palliative Care ◽  
Frequency Distribution ◽  
Advanced Cancer ◽  
Hospitalized Patients ◽  
Prognostic Uncertainty

Symptom burden, functional status, and clinical outcomes of hospitalized patients with advanced genitourinary cancers.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 42-42
Author(s):  
Daniel E Lage ◽  
M Dror Michaelson ◽  
Christopher Sweeney ◽  
Erika D. Barrett ◽  
Kara Marie Olivier ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Functional Status ◽  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
Functional Impairment ◽  
Symptom Management ◽  
Symptom Burden ◽  
Hospitalized Patients ◽  
Adrenal Cancer ◽  
Cancer Types

42 Background: Patients with advanced genitourinary (GU) cancers are often hospitalized for complications of their cancer and symptom management. Yet, little is known about the symptom burden, functional status, and health care utilization of these patients. Methods: We prospectively enrolled patients with advanced cancer who experienced unplanned hospitalizations at an academic medical center. Upon admission, we asked patients to self-report their physical (Edmonton Symptom Assessment Scale-revised [ESAS-r]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We also collected data from nursing assessments about impairments in activities of daily living (ADLs). We compared symptoms, functional impairment, readmissions, and overall survival (OS) between cancer types (dichotomizing GU cancers vs other cancer types) and within GU cancers (dichotomizing prostate cancer vs kidney/bladder/adrenal cancer) using univariate and multivariable regression analyses adjusted for age, sex, education, comorbidities, and time since advanced cancer diagnosis. Results: Among 971 patients enrolled, 106 (10.9%) had advanced GU cancers (39.6% prostate cancer, 32.1% kidney cancer, 25.5% bladder cancer, and 2.8% adrenal cancer). Compared to patients with other cancer types, patients with GU cancers were older (median: 69.0 vs 64.0 years, p < 0.001) and had more time since advanced cancer diagnosis (median: 14.0 vs 7.0 months, p < 0.001). In univariate analyses, a greater proportion of patients with GU cancers had an ADL impairment (57.5% vs 38.0%, p < 0.001) compared to other cancer types but the groups did not differ in their physical (Mean = 33.3 vs 32.6, p = 0.61) or depression (Mean = 4.1 vs 3.3, p = 0.05) symptoms. In multivariable models, patients with GU cancers had similar risk of readmission in 90 days (HR 1.31, p = 0.077), but worse survival (median OS: 102.0 days vs 133.5 days, p < 0.001; HR 1.27, p = 0.046). Within GU cancers, patients with kidney/bladder/adrenal cancer (vs. prostate cancer) were younger (median: 66.0 vs 74.0, p < 0.001) with less time since advanced cancer diagnosis (median: 9.0 vs 23.0 months, p = 0.012) but had no difference in symptoms or functional impairment. They were more likely to be admitted for symptom management (66% vs. 39% for prostate cancer, p = 0.026). Patients with kidney/bladder/adrenal cancer also had higher risk of readmission (HR 2.04, p = 0.043) but no difference in OS, compared to patients with prostate cancer. Conclusions: We found that hospitalized patients with advanced GU cancers had significantly greater functional impairment and worse survival compared to those with other cancer types, and those with kidney/bladder/adrenal cancer had significantly higher readmission risk compared to those with prostate cancer. These findings support the need to develop tailored supportive care for hospitalized patients with GU cancers.

Quality of life, depression, and end-of-life outcomes in hospitalized patients with advanced cancer.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 9525-9525
Author(s):  
Kathryn Elizabeth Hudson ◽  
Steven Paul Wolf ◽  
Amy Pickar Abernethy ◽  
Thomas William LeBlanc
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Advanced Cancer ◽  
Hospitalized Patients ◽  
Life Outcomes

Symptom burden in hospitalized patients with advanced cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 100-100 ◽  
Author(s):  
Samantha M.C. Moran ◽  
Areej El-Jawahri ◽  
William F. Pirl ◽  
Lara Traeger ◽  
Pallavi Kumar ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Hospital Admissions ◽  
Psychological Symptoms ◽  
Massachusetts General Hospital ◽  
Symptom Burden ◽  
Hematologic Malignancies ◽  
Psychological Needs ◽  
Physical Symptoms ◽  
Hospitalized Patients ◽  
Assessment System

100 Background: Patients with advanced cancer experience high rates of both physical and psychological morbidity, but data describing patients’ symptoms during hospital admissions are lacking. We sought to describe symptom burden in hospitalized patients with incurable solid and hematologic malignancies. Methods: We prospectively enrolled patients with incurable cancers admitted to the Massachusetts General Hospital from 9/1/2014 through 5/1/2015. Within the first week of their admission, we assessed physical and psychological symptoms using the Edmonton Symptom Assessment System-revised (ESAS-r). Beginning 11/15/2015, we also administered the Patient Health Questionnaire 4 (PHQ-4), scored categorically. Results: We enrolled 457 of 547 (84%) eligible patients. Participants (mean age=63.8 years; n=231, 51% female) had the following malignancies: gastrointestinal (n=149, 33%), lung (n=77, 17%), genitourinary (n=52, 11%), breast (n=33, 7%), hematologic (n=24, 5%), and other solid tumors (n=122, 27%). Using the ESAS-r, tiredness, drowsiness, anorexia, and pain were the most common severe symptoms. Using the PHQ-4, approximately one-third of participants screened positive for depression (91/271, 34%) and anxiety (86/273, 32%). Conclusions: Hospitalized patients with incurable solid and hematologic malignancies experience substantial physical and psychological symptoms. Most patients reported at least moderate tiredness, drowsiness, anorexia and pain. Additionally, a concerning proportion reported depression and anxiety. Our data demonstrate the need for efforts to alleviate the physical symptoms experienced by this population, while also seeking to understand and address their psychological needs. [Table: see text]

Randomized trial of a symptom monitoring intervention for hospitalized patients with advanced cancer (NCT03396510).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12014-12014
Author(s):  
Ryan David Nipp ◽  
Nora K. Horick ◽  
Carolyn L. Qian ◽  
Emilia R. Kaslow-Zieve ◽  
Chinenye C. Azoba ◽  
...  
Keyword(s):  
Health Care ◽  
Usual Care ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Hospitalized Patients ◽  
Health Care Use ◽  
Assessment System ◽  
Readmission Rates ◽  
Symptom Monitoring ◽  
Secondary Endpoints

12014 Background: Hospitalized patients with advanced cancer experience a high symptom burden, which is associated with poor clinical outcomes and increased health care use. Symptom monitoring interventions are increasingly becoming standard of care in oncology, but studies of these interventions in the hospital setting are lacking. We evaluated the impact of a symptom monitoring intervention in hospitalized patients with advanced cancer. Methods: We randomly assigned hospitalized patients with advanced cancer who were admitted to the oncology service to a symptom monitoring intervention or usual care. Patients in both arms reported their symptoms (Edmonton Symptom Assessment System [ESAS] and Patient Health Questionnaire 4 [PHQ4], higher scores on both indicate greater symptom severity) daily via tablet computers. Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily oncology rounds. The primary endpoint was the proportion of days with improved symptoms for those who completed two or more days of symptoms. Secondary endpoints included hospital length of stay (LOS) and readmission rates. Results: From 2/2018-10/2019, we randomized 390 patients (76.2% enrollment rate); 320 completed two or more days of symptoms (median age=65.6 [range 18.8-93.2]; 43.8% female). The most common cancers were gastrointestinal (36.9%), lung (18.8%), and genitourinary (12.2%). Nearly half of patients (48.5%) had one or more comorbid conditions in addition to cancer. We found no significant differences between intervention and usual care regarding the proportion of days with improved ESAS total (B=-0.05, P=.17), ESAS physical (B=-0.02, P=.52), PHQ4 anxiety (B=-0.03, P=.33), and PHQ4 depression (B=-0.02, P=.44) symptoms. Intervention patients also did not differ from usual care with respect to secondary endpoints of hospital LOS (7.50 v 7.59 days, P=.88) and readmission rates within 30 days of discharge (32.5% v 25.6%, P=.18). Conclusions: For hospitalized patients with advanced cancer, this symptom monitoring intervention did not have a significant impact on their symptom burden and health care use. These findings do not support the routine integration of this type of symptom monitoring intervention for hospitalized patients with advanced cancer. The positive outcomes seen in previous studies of symptom monitoring interventions may not be reproduced in other patient populations and care settings. Support: UG1CA189823; Clinical trial information: NCT03396510 .

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