Functional Status May Predict Outcomes in Hospitalized Patients With Advanced Cancer

WHAT WAS LEARNED

The researchers found 390 patients (40.2%) had at least 1 ADL impairment and 14.8% had 1 or 2 ADL impairments. The most common ADLs involved mobility (37.7%), bathing (25.9%), and dressing (24.0%). A total of 25.4% experienced at least 3 areas of difficulty with daily tasks. Compared with patients who had no functional impairment, patients with functional impairment tended to be older (mean age, 67.18 vs 60.81 years) and had higher physical symptom burdens (mean ESAS physical score, 35.29 vs 30.85).

“We were surprised by the remarkably high rates of functional impairment in this population. Additionally, we demonstrated novel results regarding the associations of limitations in daily activities with patients’ physical and psychological symptoms,” said Dr Lage (email communication, June 2020).

The researchers found that functional impairment was associated with longer LOS and worse survival. Dr Lage said only half of patients with functional limitations had a palliative care consultation despite their high symptom burden, underscoring the need for efforts to increase access to palliative care.  In this current study, the patients with functional impairment were more likely to report moderate-to-severe pain (74.9% vs 63.1%), symptoms of depression (38.3% vs 23.6%), and anxiety (35.9% vs 22.4%). “We found that patients who need assistance with daily activities had higher rates of clinically significant anxiety and depression symptoms, which merits further study and highlights the need for interventions targeting these patients’ unique needs,” said Dr Lage.

IMPLICATIONS FOR NURSES

These findings suggest that routine assessment of functional status upon hospital admission is critical for improving outcomes and to inform discharge planning in this patient population. Senior researcher Ryan D. Nipp, MD, MPH, a gastrointestinal oncologist and health services researcher at MGH Cancer Center and the Shelby Memorial Professor of Medicine in the Field of Cancer Therapeutics, Medicine, Harvard Medical School, Boston, Massachusetts, said an important aspect of this study is that the data on patients’ functional impairment was documented by the inpatient nurses as part of routine care.

“Nurses often care for patients with limited function in the inpatient setting and provide critical support for these patients and their loved ones. Nurses play a central role in identifying patients at-risk for functional limitations, and we hope that our work provides data supporting the need to assess and address these limitations, while also highlighting that these patients often also experience a high symptom burden,” Dr Nipp said (email communication, June 2020).

In the future, the team hopes to build upon this work by developing and testing strategies to integrate interventions, such as physical/occupational therapy and/or palliative care, earlier in the course of a patient’s care to help address their functional impairment and symptom burden. “A key first step entails the routine assessment and identification of patients with difficulty performing their daily activities right from the moment they are admitted to the hospital,” noted Dr Nipp. Earlier identification of functional impairment would enable clinicians to integrate interventions that address hospitalized patients’ physical function, symptom burden, and other important clinical outcomes, he concluded.

Reference

Lage DE, El-Jawahri A, Fuh CX, et al. Functional impairment, symptom burden, and clinical outcomes among hospitalized patients with advanced cancer. J Natl Compr Canc Netw 2020;18(6):747–754.