The importance of recognizing and addressing depression in patients with advanced cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10050-10050
Author(s):  
Risa Wong ◽  
Areej El-Jawahri ◽  
Kelly Irwin ◽  
Sara D'Arpino ◽  
Samantha M.C. Moran ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Advanced Cancer ◽  
Antidepressant Medication ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Data Repository ◽  
Patients With Cancer ◽  
Time Of Admission ◽  
The Relationship

10050 Background: Patients with cancer often experience depression, which is associated with worse outcomes, including longer hospital length of stay (LOS). Although antidepressant medication can improve depressive symptoms in patients with cancer, it is unclear whether their use translates into better outcomes. We sought to clarify the relationship between depressive symptoms, antidepressant medication, and hospital LOS in patients with advanced cancer. Methods: We enrolled hospitalized patients with advanced cancer from 9/2014 to 4/2016 as part of a longitudinal data repository. We examined patients’ medical records to obtain information about documented depressive symptoms in the 3 months prior to admission and use of antidepressant medication at the time of admission. Using descriptive statistics, we compared differences in patient characteristics and hospital LOS across these groups. We used linear regression to examine associations and moderation effects between depressive symptoms, use of antidepressant medication, and hospital LOS. Results: Of 1,036 enrolled patients (89.9% of approached), 126 (12.2%) had documented depressive symptoms in the 3 months prior to admission and 288 (27.8%) were taking an antidepressant medication at the time of admission. Patients with depressive symptoms were more likely to be on antidepressant medication at admission than those without depressive symptoms (48.4% vs 24.9%, p < .001). Patients taking antidepressant medication were younger (62.4 vs 64.4 years, p = .026) and more likely to be female (55.2% vs 47.2%, p = .021). Depressive symptoms were associated with longer hospital LOS (7.3 vs 6.1 days, p = .036), and antidepressant medication was a moderator of this relationship. Among patients not on antidepressant medication, depressive symptoms were associated with longer hospital LOS (7.9 vs 6.1 days, p = .025), but among those on antidepressant medication, depressive symptoms were not associated with hospital LOS (6.6 vs 6.2 days, p = .588). Conclusions: Antidepressant medication moderated the relationship between depressive symptoms and longer hospital LOS. Our results support the need to recognize and address depressive symptoms in patients with advanced cancer.

scholarly journals Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer

2018 ◽  
Vol 24 (1) ◽  
pp. 117-124 ◽  
Author(s):  
Risa L. Wong ◽  
Areej El‐Jawahri ◽  
Sara M. D'Arpino ◽  
Charn‐Xin Fuh ◽  
P. Connor Johnson ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Length Of Stay ◽  
Advanced Cancer ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Antidepressant Medications ◽  
The Relationship

Association of impairments in activities of daily living (ADLs) with symptom burden, health care utilization, and survival among hospitalized patients with advanced cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 203-203
Author(s):  
Daniel E Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard Newcomb ◽  
Vicki Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Advanced Cancer ◽  
Charlson Comorbidity Index ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Cancer Type ◽  
Comorbidity Index ◽  
The Relationship

203 Background: Hospitalized patients with cancer often have impaired ADLs related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between ADL impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (67.2 vs. 60.8 years, p<0.001), had higher Charlson comorbidity index (1.1 vs. 0.7, p<0.001), and higher physical symptom burden (ESAS Physical 35.2 vs. 30.9, p<0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p<0.01), pain (74.9% vs. 63.1%, p<0.01), drowsiness (76.6% vs. 68.3%, p<0.01), as well as symptoms of depression (38.3% vs. 23.6%, p<0.01) and anxiety (35.9% vs. 22.4%, p<0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B=1.30, p<0.01), higher odds of death or readmission within 90 days (odds ratio=2.26, p<0.01), and worse survival (hazard ratio=1.73, p<0.01). Conclusions: Hospitalized patients with advanced cancer who have ADL impairment experience a significantly higher symptom burden and worse health outcomes compared to those without ADL impairment. These findings highlight the need to assess and address ADL impairment among this population to enhance their quality of life and care.

Impact of cancer in pulmonary embolism presentation and outcomes: A large academic center study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6613-6613
Author(s):  
Cherry Au ◽  
Ena Gupta ◽  
Phue Khaing ◽  
Joseph DiBello ◽  
Tayoot Chengsupanimit ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Indwelling Catheters ◽  
Comfort Care ◽  
Patients With Cancer ◽  
Hazards Model ◽  
Academic Center

6613 Background: The risk of venous thromboembolism is increased 4- to 7-fold in patients with malignancy, emphasizing the need to identify and treat these patients early to improve outcomes. We aimed to study the clinical presentation and outcomes of pulmonary embolism (PE) in patients with and without cancer. Methods: We performed a retrospective analysis of consecutive patients diagnosed with PE via CT scan from 2014-2016 at Jefferson Hospital. We compared patient characteristics, presentation, PE characteristics and mortality of patients with and without cancer. Cox proportional regression hazards model was used for survival-time analysis. Results: Our study included 581 patients, of which 187 (32.1%) had active cancer. Cancer patients were less likely to have chest pain (18.2% vs 37.4% p < 0.01), syncope (2.7% vs 6.6% p = 0.05), bilateral PEs (50% vs 60% p = 0.025), and right heart strain (RHS) (48% vs 58% p = 0.024). Indwelling catheters (IC) were present in 41.2% (n = 77) of cancer patients. However, presence of IC was not associated finding of incidental PEs (26% vs 18.2% p = 0.201). There was no difference in hospital length of stay (8.9 vs 9.4 days p = 0.61) or intensive care unit admission (31.9% vs 33.3% p = 0.75). There were fewer massive PE (3.2% vs 7.1% p = 0.06) in patients with cancer, but this difference was not statistically significant. Cancer patients elected comfort care at higher rates (15.2% vs 5.4% p = 0.01). Cancer patients had higher 1-year mortality as compared to non-cancer (adj HR 6.9, 95% CI 3.3- 14.7, p < 0.01). Among cancer patients, 52.7% had metastasis with a higher 1-year mortality (adj HR 2.5, 95% CI 1.8- 4.9, p < 0.1) and 35.8% were on active chemotherapy with no difference in 1-year survival (adj HR 1.1, 95% CI 0.6-1.8, p = 0.79). The most represented cancers were genitourinary, lung and head and neck (35.3%, 23.0%, 13.4%, respectively). Conclusions: Cancer patients presented with less severe pulmonary emboli which may be due to increased health care contact and pre-clinical suspicion. The presence of IC did not affect the size, location of PE or incidental PEs among cancer patients. Although cancer patients have higher 1-year mortality, PE may not be as large as a contributor as previously perceived.

Functional impairment on admission and associated symptom burden and health outcomes among hospitalized patients with advanced cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11554-11554
Author(s):  
Daniel E Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard Newcomb ◽  
Vicki Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Health Outcomes ◽  
Advanced Cancer ◽  
Functional Impairment ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Comorbidity Index ◽  
The Relationship

11554 Background: Hospitalized patients with cancer often have impaired function, as measured by activities of daily living (ADLs), related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between functional impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment on admission and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (Mean = 67.2 vs 60.8 years, p < 0.001), had higher Charlson comorbidity index (Mean = 1.1 vs 0.7, p < 0.001), and higher physical symptom burden (ESAS Physical Mean = 35.2 vs 30.9, p < 0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p < 0.01), pain (74.9% vs. 63.1%, p < 0.01), drowsiness (76.6% vs. 68.3%, p < 0.01), as well as symptoms of depression (38.3% vs. 23.6%, p < 0.01) and anxiety (35.9% vs. 22.4%, p < 0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B = 1.30, p < 0.01), higher odds of death or readmission within 90 days (odds ratio = 2.26, p < 0.01), and higher mortality (hazard ratio = 1.73, p < 0.01). Conclusions: Hospitalized patients with advanced cancer who have functional impairment experience a significantly higher symptom burden and worse health outcomes compared to those without functional impairment. These findings highlight the need to assess and address functional impairment among this population to enhance their quality of life and care.

Abstract 17191: Intraprocedural Dobutamine Use is Independently Associated With Prolonged Length of Stay (LOS) Following Ventricular Tachycardia (VT) Ablation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Jeffrey D Graham ◽  
Michael Rosenberg ◽  
Amneet Sandhu ◽  
Alexis Tumolo ◽  
Wendy Tzou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Impact Factors ◽  
Vasoactive Drugs ◽  
Prolonged Length ◽  
Procedural Time ◽  
Minimal Data ◽  
Vt Ablation

Introduction: Use of inotropes such as dobutamine remains controversial in the management of heart failure (HF) due to uncertain efficacy and lack of mortality benefit. Furthermore, vasoactive drugs are frequently utilized during VT ablations despite minimal data regarding their effects on outcomes. Vasoactive drugs may impact factors such as long-term VT recurrences and hospital length of stay. Hypothesis: We sought to evaluate the hypothesis that the use of dopamine, dobutamine or phenylephrine have differential effects on outcomes after VT ablations. Methods: A retrospective analysis was completed for all VT ablations from 2013-17 at our institution. Patient characteristics and procedural details were collected for 149 VT ablation cases. Results: The cohort was 81% male, and 67% had cardiomyopathy of which 53% were ischemic with a mean EF of 29% (CI 26.7- 31.4). Average procedure time was 368 minutes (CI 347-388). Vasoactive drugs were used in 87% of patients undergoing VT ablation: phenylephrine (67%), dopamine (40%), dobutamine (37%). The median LOS for all patients was 5 days (mean 7 days, range 1 - 56 days, IQR 2 - 9 days). After adjusting for inducibility, HF and procedural time, the dose of dobutamine, but not dopamine or phenylephrine, was significantly associated with increased length of stay (Fig. 1a). Inducible VT at the end of the procedure also correlated with increased LOS (5.4±0.3 vs 8.6±0.3, p < 0.0001). Procedural time did not associate with increased LOS. Of all covariates, only the number of VTs induced during the procedure was significantly associated with increased VT recurrence (HR 1.22/VT morphology (CI 1.11-1.34, p < 0.001)). Conclusions: Dobutamine, but not phenylephrine or dopamine, was significantly associated with increased length of stay after adjusting for HF, procedural time and inducibility of VT. More research is needed regarding vasoactive drug use in VT ablations and their significance to procedural and post-procedure outcomes.

scholarly journals Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

2019 ◽  
Vol 15 (1) ◽  
pp. e74-e83 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Zhanni Lu ◽  
Suresh K. Reddy ◽  
EdenMae C. Rodriguez ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

scholarly journals Association between Insurance Status and Hospital Length of Stay following Trauma

2016 ◽  
Vol 82 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Brian R. Englum ◽  
Xuan Hui ◽  
Cheryl K. Zogg ◽  
Muhammad Ali Chaudhary ◽  
Cassandra Villegas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Trauma Patients ◽  
Uninsured Patients ◽  
National Trauma ◽  
Insured Patients ◽  
The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

Does Travel Distance Affect Readmission Rates after Cardiac Surgery?

2017 ◽  
Vol 83 (10) ◽  
pp. 1170-1173
Author(s):  
Yen-yi Juo ◽  
Alexis Woods ◽  
Ryan Ou ◽  
Gianna Ramos ◽  
Richard Shemin ◽  
...  
Keyword(s):  
Medical Center ◽  
Surgical Care ◽  
Hospital Length ◽  
Travel Distance ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Logistic Regression Models ◽  
Caucasian Race ◽  
The Impact ◽  
The Relationship

With emphasis on value-based health care, empiric models are used to estimate expected read-mission rates for individual institutions. The aim of this study was to determine the relationship between distance traveled to seek surgical care and likelihood of readmission in adult patients undergoing cardiac operations at a single medical center. All adults undergoing major cardiac surgeries from 2008 to 2015 were included. Patients were stratified by travel distance into regional and distant travel groups. Multivariable logistic regression models were developed to assess the impact of distance traveled on odds of readmission. Of the 4232 patients analyzed, 29 per cent were in the regional group and 71 per cent in the distant. Baseline characteristics between the two groups were comparable except mean age (62 vs 61 years, P < 0.01) and Caucasian race (59 vs 73%, P < 0.01). Distant travel was associated with a significantly longer hospital length of stay (11.8 vs 10.5 days, P < 0.01) and lower risk of readmission (9.5 vs 13.4%, P < 0.01). Odds of readmission was inversely associated with logarithm of distance traveled (odds ratio 0.75). Travel distance in patients undergoing major cardiac surgeries was inversely associated with odds of readmission.

Does Platelet Administration Affect Mortality in Elderly Head-Injured Patients Taking Antiplatelet Medications?

2009 ◽  
Vol 75 (11) ◽  
pp. 1100-1103 ◽  
Author(s):  
Douglas M. Downey ◽  
Benjamin Monson ◽  
Karyn L. Butler ◽  
Gerald R. Fortuna ◽  
Jonathan M. Saxe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Platelet Transfusion ◽  
Injury Severity ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head Injured ◽  
Outcome Differences ◽  
Level I ◽  
Injured Patients

A significant portion of patients sustaining traumatic brain injury (TBI) take antiplatelet medications (aspirin or clopidogrel), which have been associated with increased morbidity and mortality. In an attempt to alleviate the risk of increased bleeding, platelet transfusion has become standard practice in some institutions. This study was designed to determine if platelet transfusion reduces mortality in patients with TBI on antiplatelet medications. Databases from two Level I trauma centers were reviewed. Patients with TBI 50 years of age or older with documented preinjury use of clopidogrel or aspirin were included in our cohort. Patients who received platelet transfusions were compared with those who did not to assess outcome differences between them. Demographics and other patient characteristics abstracted included Injury Severity Score, Glasgow Coma Scale, hospital length of stay, and warfarin use. Three hundred twenty-eight patients comprised the study group. Of these patients, 166 received platelet transfusion and 162 patients did not. Patients who received platelets had a mortality rate of 17.5 per cent (29 of 166), whereas those who did not receive platelets had a mortality rate of 16.7 per cent (27 of 162) ( P = 0.85). Transfusion of platelets in patients with TBI using antiplatelet therapy did not reduce mortality.

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