Functional Status May Predict Outcomes in Hospitalized Patients With Advanced Cancer

A new study is suggesting many hospitalized adults with advanced cancer have problems with functional impairment and this is affecting their outcomes. The study findings, which were published in JNCCN — Journal of the National Comprehensive Cancer Network, revealed that 40.2% of hospitalized patients with advanced, incurable cancer were functionally impaired at the time of hospital admission. The study also showed that functional impairment was associated with higher rates of pain, depression, anxiety, longer hospital stays, and worse survival.

“While previous studies have shown that functional status represents an important predictor of survival and other clinical outcomes in the outpatient setting, little was known about how these factors relate in the hospital setting. Additionally, studies linking functional status with patients’ symptom burden were lacking,” said lead researcher Daniel E. Lage, MD, with the Massachusetts General Hospital (MGH) Cancer Cancer in Boston, Massachusetts.

THE STUDY

The researchers examined how functional impairment is associated with symptom burden, healthcare utilization, and clinical outcomes by conducting a prospective observational study of 971 patients with advanced cancer. All the patients were aged 18 years and older and had unplanned hospitalizations at a single institution between September 2014 and March 2016. The researchers examined electronic health records (EHRs) and also collected self-completed patient questionnaires.

Nurses at the time of admission assessed each patient’s activities of daily living (ADLs) and determined functional impairment. The team used the revised Edmonton Symptom Assessment System (ESAS-r) to measure physical symptoms and Patient Health Questionnaire-4 to measure psychological symptoms. The researchers used multivariable regression models to examine the relationships between functional impairment, hospital length of stay (LOS), and survival.

The mean age was 63.4 years (range, 20 to 92 years), and the cohort was 92.5% white. Among these participants, 60.9% had an education level above high school. The patients had a variety of cancer types (31.9% had gastrointestinal cancer, 18.2% had lung cancer, 10.9% had genitourinary cancer, 7.4% had breast cancer, and 31.5% had another cancer type). The most common reasons for patient admission included symptom management (56.0%); fever or infections (24.6%); fatigue, weakness, or failure to thrive (13.5%); and metabolic disarray or laboratory abnormalities (5.9%).