Hospitalizations following cancer diagnosis: National values for frequency, duration, and charges.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12039-12039 ◽  
Author(s):  
Michael T. Halpern ◽  
Fanni Zhang ◽  
Lindsey Enewold
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hematologic Malignancies ◽  
Cancer Type ◽  
Older Individuals ◽  
Breast Cancer Patients ◽  
Chemotherapy Administration ◽  
Medical Care Costs ◽  
Nationally Representative ◽  
Care Costs

12039 Background: US medical care costs for cancer are projected to be $158 billion in 2020. Hospitalization is a substantial component of these costs; however, little is known about national patterns of hospitalization among individuals with cancer. This study used Medicare data to determine national rates and charges for hospitalizations among older cancer patients. Methods: We used data from 100% of individuals diagnosed with cancer in SEER-Medicare in the most recent 5 years available, 2011-2015. Analyses determined proportion of patients hospitalized, number/duration of hospitalizations, and charges by patient clinical and sociodemographic characteristics within 12 months of diagnosis. Results: Among 307,944 unique patients, 65% were hospitalized in the first year following diagnosis. Rates ranged from 34% for patients with in situ disease to 82%-84% for patients with advanced disease; 31% had 2 or more hospitalizations. Hospitalization rates were lowest among skin melanoma (25%) and breast (42%) cancer patients, highest for brain/nervous system (97%) and ovarian (96%) cancer patients. Hospitalized patients had a mean of 2.1 hospitalizations; mean days per hospitalization within 12 months was 8.8 (median 4). Duration of hospitalization varied little by stage at diagnosis. Mean days per hospitalization was shortest for thyroid and prostate cancer patients (5.7 & 6.0 days), longest for colorectal cancer and leukemia patients (10.6 & 11.3 days). DRGs varied substantially by cancer type; DRG for chemotherapy administration was more frequent among hospitalizations for patients with hematologic malignancies or distant stage disease. Mean Medicare charge (2016 $) per hospitalization was $67,368 (median $41,973), and was lowest for breast cancer patients ($48,021), highest for leukemia patients ($91,799). Patient charges per hospitalization averaged $1107 (median $1317) and showed little variation by cancer type or stage. Conclusions: Most older individuals experience at least one hospitalization within 12 months of cancer diagnosis. Frequency, duration, and charges of hospitalizations vary by cancer type and stage. This nationally representative information will aid in projecting cancer care costs and potential economic impacts of new therapies and treatment program.

National Cancer Diagnosis Audit: initial results on avoidable delays

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696677
Author(s):  
Ruth Swann ◽  
ÒJana Witt ◽  
Brian Shand ◽  
Georgios Lyratzopoulos ◽  
Sara Hiom ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Primary Care Data ◽  
Diagnosis Of Cancer

BackgroundAn earlier diagnosis of cancer can increase cancer survival and quality of life. Characterising avoidable delays to a patient’s diagnosis of cancer can help to direct quality improvement initiatives.AimTo evaluate avoidable delays to cancer diagnoses and the variation by cancer type and patient characteristics using primary care data collected as part of the National Cancer Diagnosis Audit (NCDA).MethodEnglish general practices participating in the NCDA (439) entered primary care data on patients (17,042) diagnosed with cancer in 2014. Using a taxonomy developed from the National Audit of Cancer Diagnosis in Primary Care (2011), GPs reported delays to the diagnosis that in their judgement were avoidable.ResultsIn 22% of NCDA patient records (n = 3380), the GP considered there to be an avoidable delay to the patient receiving their cancer diagnosis. There was variation by cancer type; 7% of breast cancer patients experienced delays compared to 34% of stomach cancer patients. 49% of avoidable delays occurred in primary care and 38% in secondary or tertiary care. Of all delays, 28% were attributed to clinician factors and 34% to health care system factors. Results will be presented by patient characteristics.ConclusionPrimary care data from the NCDA can be used to better understand potentially avoidable delays to diagnosis and identify possible solutions for improving the diagnostic pathway. Avoidable delays during cancer diagnosis occur for many reasons. These insights can inform quality improvement initiatives, which should be directed at both clinical and organisational factors in primary care and hospital settings.

scholarly journals Thrombocytopenia Among Patients with Hematologic Malignancies and Solid Tumors: Risk and Prognosis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3156-3156
Author(s):  
Kasper Adelborg ◽  
Katalin Veres ◽  
Erzsébet Horváth-Puhó ◽  
Mary Clouser ◽  
Hossam A Saad ◽  
...  
Keyword(s):  
Platelet Count ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Clinical Outcomes ◽  
Cancer Diagnosis ◽  
Hematologic Malignancies ◽  
Severe Thrombocytopenia ◽  
Cancer Type ◽  
Risk Of Death ◽  
Study Inclusion

Abstract Introduction: Despite the large body of research in cancer and increasing numbers of cancer survivors, knowledge about the risks and prognoses related to thrombocytopenia in the clinical care setting is scarce. Such information is important to understanding the need and potential impact of platelet transfusion and emerging drug therapies for thrombocytopenia. In this study, we examined the risk of thrombocytopenia among patients with incident cancer. Further, we studied the extent to which thrombocytopenia was associated with adverse clinical outcomes. Methods: This population-based cohort study was conducted using data from the Danish Cancer Registry. All patients diagnosed with incident hematologic malignancies and solid tumors (age of ≥18 years) during 2015─2018 were identified. Data were linked with routine laboratory test results from the primary care and hospital settings, as recorded in the Danish Register of Laboratory Results for Research. Based on platelet count levels (x 10 9/L), thrombocytopenia was categorized as grade 0 (any count)<150; grade 1:<100; grade 2:<75; grade 3:<50; and grade 4: <25. We tabulated the prevalence of thrombocytopenia at study inclusion and calculated the cumulative incidence proportion (risk) of thrombocytopenia, accounting for the competing risk of death. Each patient with thrombocytopenia was matched up to 5 cancer patients without thrombocytopenia by age, sex, cancer type, cancer stage, and time from cancer diagnosis and index date. Cox proportional hazards regression analysis was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) of adverse clinical outcomes, including any bleeding leading to hospitalization, site-specific bleeding leading to hospitalization, transfusion (red blood cell, platelet, or fresh frozen plasma), and death. HRs were adjusted for Charlson Comorbidity Index scores and matching factors by design. Results: The analytic cohort comprised 11,785 patients with hematologic malignancies and 57,600 patients with solid tumors (median age=70 years). Any thrombocytopenia was observed during the 6 months preceding study inclusion among 18% of patients with hematologic malignancies (grades 1-2: 6% and grades 3-4: 5%) and 4% of patients with solid tumors (grades 1-2: 1% and grades 3-4: 0%). The 1-year and 4-year risks of new-onset thrombocytopenia were 30% and 40% for hematologic malignancies and 21% and 28% for solid tumors, respectively (Figure 1). Among patients who initiated chemotherapy following their cancer diagnosis (n=33,165), the 1-year and 4-year risks of thrombocytopenia were 50% and 62% for hematologic malignancies and 39% and 49% for solid tumors, respectively (Figure 2). Patients with grade 4 thrombocytopenia had higher rates of any bleeding leading to hospitalization than patients without thrombocytopenia [hematologic malignancies: HR=2.31 (95% CI: 1.43-3.73) and solid tumors: HR=4.52 (95% CI: 2.00-10.24)], while grades 1-3 thrombocytopenia did not confer a significantly increased rate of hospitalization for bleeding (Table 1). All grades of thrombocytopenia were associated with an increased rate of transfusion [overall for hematologic malignancies: HR=2.06 (95% CI: 1.91-2.23), and overall for solid tumors: HR=2.13 (95% CI: 1.83-2.48)] and with death [overall for hematologic malignancies: HR=2.01 (95% CI: 1.84-2.20), and overall for solid tumors: HR=1.44 (95% CI: 1.39-1.49)]. These associations increased in magnitude with decreasing platelet count levels. Conclusions: The risk of thrombocytopenia was substantial following a diagnosis of incident hematologic malignancy and solid tumors, with higher risks among patients who initiated chemotherapy. While only severe thrombocytopenia was a predictor of any hospitalization for bleeding, all grades of thrombocytopenia were associated with increased rates of transfusion and death. Our findings support the need for regular assessment of platelet count levels to identify cancer patients at risk of serious clinical outcomes. Figure 1 Figure 1. Disclosures Clouser: Amgen: Current Employment, Other: This work is related to Chemotherapy Induced Thrombocytopenia as a disease state, in this essence it is not directly related to an Amgen product; CIT is an area of scientific interest to Amgen with Romiplostim under development for this potential indicati. Saad: Amgen: Current Employment, Current equity holder in publicly-traded company.

scholarly journals Physical Comorbidities and Depression in Recent and Long-Term Adult Cancer Survivors: NHANES 2007–2018

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3368
Author(s):  
Dafina Petrova ◽  
Andrés Catena ◽  
Miguel Rodríguez-Barranco ◽  
Daniel Redondo-Sánchez ◽  
Eloísa Bayo-Lozano ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Depression Symptoms ◽  
Depression Risk ◽  
Adult Cancer Survivors ◽  
Before And After ◽  
Nationally Representative ◽  
Risk Of Cancer

Many adult cancer patients present one or more physical comorbidities. Besides interfering with treatment and prognosis, physical comorbidities could also increase the already heightened psychological risk of cancer patients. To test this possibility, we investigated the relationship between physical comorbidities with depression symptoms in a sample of 2073 adult cancer survivors drawn from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2007–2018) in the U.S. Based on information regarding 16 chronic conditions, the number of comorbidities diagnosed before and after the cancer diagnosis was calculated. The number of comorbidities present at the moment of cancer diagnosis was significantly related to depression risk in recent but not in long-term survivors. Recent survivors who suffered multimorbidity had 3.48 (95% CI 1.26–9.55) times the odds of reporting significant depressive symptoms up to 5 years after the cancer diagnosis. The effect of comorbidities was strongest among survivors of breast cancer. The comorbidities with strongest influence on depression risk were stroke, kidney disease, hypertension, obesity, asthma, and arthritis. Information about comorbidities is usually readily available and could be useful in streamlining depression screening or targeting prevention efforts in cancer patients and survivors. A multidimensional model of the interaction between cancer and other physical comorbidities on mental health is proposed.

scholarly journals What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?

2021 ◽  
Author(s):  
C. T. Sánchez-Díaz ◽  
S. Strayhorn ◽  
S. Tejeda ◽  
G. Vijayasiri ◽  
G. H. Rauscher ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Social Support ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Psychosocial Stress ◽  
Breast Cancer Diagnosis ◽  
Support Needs ◽  
Breast Cancer Patients ◽  
Hispanic Patients ◽  
Racial Ethnic

Abstract Background Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. Methods Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25–79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. Results Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. Conclusions SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).

Attention to diet, exercise, and weight in the oncology clinic: Results of a national patient survey.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10549-10549
Author(s):  
Jennifer A. Ligibel ◽  
Lori J. Pierce ◽  
Catherine M. Bender ◽  
Tracy E Crane ◽  
Christina Marie Dieli-Conwright ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Online Survey ◽  
Early Stage ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Related Factors ◽  
Increased Risk ◽  
Diet And Exercise ◽  
To Receive

10549 Background: Obesity and related factors are increasingly associated with increased risk of developing and dying from cancer. The American Society of Clinical Oncology (ASCO) conducted a survey of cancer patients to assess their experience in receiving recommendations and referrals related to weight, diet and exercise as a part of their cancer care. Methods: An online survey was distributed to potential participants between March and June 2020 via ASCO channels and patient advocacy organizations, with an estimated reach of over 25,000 individuals. Eligibility criteria included being 18 years, living in the US, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. Results: In total, 2419 individuals responded to the survey. Most respondents were female (75.5%), 61.8% had an early-stage malignancy, 38.2% had advanced disease, and 49.0% were currently receiving treatment. Breast cancer was the most common cancer type (36.0%). Average BMI was 25.8 kg/m2. The majority of respondents consumed £2 servings of fruits and vegetables per day (50.9%) and exercised £2 times per week (50.4%). Exercise was addressed at most or some oncology visits in 57.5% of respondents, diet in 50.7%, and weight in 28.4%. Referrals were less common: 14.9% of respondents were referred to an exercise program, 25.6% to a dietitian and 4.5% to a weight management program. In multiple regression analyses, racial and ethnicity minority respondents were more likely to receive advice about diet (Odds Ratio [OR] 1.92, 95% CI 1.56-2.38) and weight (OR 1.64, 95% CI 1.23-2.17) compared to non-Hispanic whites, individuals diagnosed with cancer in the past 5 yrs (vs > 5 yrs) were more likely to receive advice about exercise (OR 1.48, 95% CI 1.23-1.79), and breast cancer patients were more likely to receive advice about exercise (OR 1.37, 95% CI 1.11-1.68) and weight (OR 1.46, 95% CI 1.03-2.07) than other cancer patients. Overall, 74% of survey respondents had changed their diet or exercise after cancer diagnosis. Respondents reporting that their oncologist spoke to them about increasing exercise or eating healthier foods were more likely to report a change in behavior than those whose oncologists did not (exercise: 79.6% vs 69.0%, P < 0.001; diet 81.1% vs 71.4%, P < 0.001). Respondents whose oncologist had spoken to them about exercise were more likely to exercise > 2 times per week compared to respondents whose oncologists did not address exercise (53.5% vs 44.1%, P < 0.001). Conclusions: In a national survey of oncology patients, slightly more than half of respondents reported attention to diet and exercise during oncology visits. Provider recommendations for diet and exercise were associated with positive changes in these behaviors. Additional attention to diet and exercise as part of oncology visits is needed to help support healthy lifestyle change in cancer patients.

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

scholarly journals Knowing Cancer Diagnosis is a Protective Factor for the Survival of Patients With Breast Cancer : A Retrospective Cohort Study

2020 ◽  
Author(s):  
Chen He ◽  
Wenxi Zhu ◽  
Yunxiang Tang ◽  
Yonghai Bai ◽  
Zheng Luo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Survival Time ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Cox Regression Analysis

Abstract Background: The health burden of breast cancer is rising in China. The effect of informed diagnosis on long-term survival has not been fully understood. This retrospective cohort study aims at exploring the association between early informed diagnosis and survival time in breast cancer patients.Methods: 12,327 breast cancer patients were enrolled between October 2002 and December 2016. Potential factors including knowing cancer diagnosis status, gender, age, clinical-stage, surgical history, the grade of reporting hospital and diagnostic year were registered. We followed up all participants every 6 months until June 2017.Results: By June 2017, 18.04% of the participants died of breast cancer. Both the 3-year and 5-year survival rate of whom knew cancer diagnosis were longer (P<0.001). By stratified analysis, except subgroups of male patients and patients in stage III, patients knowing diagnosis showed a better prognosis in all the other subgroups (P<0.05). By Cox regression analysis, it was showed that not knowing cancer diagnosis was an independent risk factor for survival in breast cancer patients (P<0.001).Conclusions: Being aware of their cancer diagnosis plays a protective role in extending the survival time in breast cancer patients, which suggests medical staff and patients’ families disclose cancer diagnosis to patients timely.

Metabonomics in cancer diagnosis: mass spectrometry-based profiling of urinary nucleosides from breast cancer patients

Biomarkers ◽  
2008 ◽  
Vol 13 (4) ◽  
pp. 435-449 ◽  
Author(s):  
Antje Frickenschmidt ◽  
Holger Fröhlich ◽  
Dino Bullinger ◽  
Andreas Zell ◽  
Stefan Laufer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mass Spectrometry ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Breast Cancer Patients ◽  
Urinary Nucleosides

COVID-related anxiety is prevalent and accurately reflects serious COVID risks in breast cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12053-12053
Author(s):  
Marisa C. Weiss ◽  
Stephanie Kjelstrom ◽  
Meghan Buckley ◽  
Adam Leitenberger ◽  
Melissa Jenkins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
P Value ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Liver And Kidney ◽  
Chi Square Test ◽  
A Current

12053 Background: A current cancer diagnosis is a risk factor for serious COVID-19 complications (CDC). In addition, the pandemic has caused major disruptions in medical care and support networks, resulting in treatment delays, limited access to doctors, worsening health disparities, social isolation; and driving higher utilization of telemedicine and online resources. Breastcancer.org has experienced a sustained surge of new and repeat users seeking urgent information and support. To better understand these unmet needs, we conducted a survey of the Breastcancer.org Community. Methods: Members of the Breastcancer.org Community were invited to complete a survey on the effects of the COVID-19 pandemic on their breast cancer care, including questions on demographics, comorbidities (including lung, heart, liver and kidney disease, asthma, diabetes, obesity, and other chronic health conditions); care delays, anxiety due to COVID-related care delays, use of telemedicine, and satisfaction with care during COVID. The survey was conducted between 4/27/2020-6/1/2020 using Survey Monkey. Results were tabulated and compared by chi square test. A p-value of 0.05 is considered significant. Data were analyzed using Stata 16.0 (Stata Corp., Inc, College Station, TX). Results: Our analysis included 568 breast cancer patients of whom 44% had ≥1 other comorbidities associated with serious COVID-19 complications (per CDC) and 37% had moderate to extreme anxiety about contracting COVID. This anxiety increased with the number of comorbidities (p=0.021), age (p=0.040), and with a current breast cancer diagnosis (p=0.011) (see table). Anxiety was significantly higher in those currently diagnosed, ≥65, or with ≥3 other comorbidities, compared to those diagnosed in the past, age <44, or without other comorbidities. Conclusions: Our survey reveals that COVID-related anxiety is prevalent at any age regardless of overall health status, but it increased with the number of other comorbidities, older age, and a current breast cancer diagnosis. Thus, reported anxiety is proportional to the risk of developing serious complications from COVID. Current breast cancer patients of all ages—especially with other comorbidities—require emotional support, safe access to their providers, and prioritization for vaccination.[Table: see text]

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