Palliative Issues Inadequately Addressed Among Hospitalized Cancer Patients

Inpatient supportive and palliative care interventions may be inadequate among hospitalized symptomatic patients with solid and hematologic cancers regardless of curability, according to an oral presentation at 2018 American Society of Clinical Oncology (ASCO) Annual Meeting.

Patients with advanced solid tumors have high symptom burdens and regularly receive supportive and palliative care, but the experience of patients with curable cancers in regard to symptoms and interventional care has not been determined.

For this single-center study, researchers assessed the outcomes of 1549 patients with cancer between September 2014 and April 2017 who experienced unplanned hospitalizations: 238 with curable hematologic cancer, 239 with curable solid cancer, 123 with incurable hematologic cancer, and 949 with incurable solid cancer. Patients completed the Edmonton Symptom Assessment System to determine physical symptoms and Patient Health Questionnaire-4 and Primary Care PTSD Screen to measure psychological distress upon admission.

Results showed that the patients with curable hematologic and curable solid cancers each reported a median number of 5 moderate-to-severe symptoms. Reported number of symptoms was a median of 5 among patients with incurable hematologic cancers and 6 among those with incurable solid tumors.

The majority of patients reported moderate-to-severe fatigue (82.9% to 86.9%), and psychological distress (eg, depression, anxiety, PTSD) was experienced by 11.8% to 21.4% of all patients.

An adjusted analysis revealed that patients with incurable solid cancers had higher symptom burden, depression, and anxiety, but did not have differences in PTSD compared with other patients.

Among patients in the top quartile of symptom burden, 16.2%, 7.9%, 23.8%, and 46.9% of patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers, respectively, received palliative care consults.

The authors concluded that “palliative care is rarely consulted for highly symptomatic patients with curable cancers. Inpatient supportive care interventions should target the needs of all highly symptomatic patients with cancer.”

Reference

Newcomb R, Nipp RD, Chan AT, et al. Symptom burden in hospitalized patients with curable and incurable cancers. Oral presentation at: 2018 ASCO Annual Meeting; June 1-5, 2018; Chicago, IL.