Functional Impairment Affects 2 in 5 Hospitalized Advanced Cancer Patients

About two in five patients hospitalized with advanced cancer suffer from functional impairment, according to a new report. These patients also experience a much higher symptom burden and worse clinical outcomes.

“Interventions addressing patients’ functional impairment and symptom management could help enhance care delivery and outcomes for the highly symptomatic population of hospitalized patients with advanced cancer,” said lead researcher Daniel E. Lage, MD, MsC, Mass General Cancer Center, in a press release. “This highlights the need for efforts to integrate functional assessments into the care of these patients to identify individuals who may benefit from physical therapy, palliative care, and/or other supportive services earlier in their hospital stay. Our finding that individuals with functional impairment experience worse survival could also help guide conversations about goals of care and hospice planning among hospitalized patients with cancer.”

Dr. Lage and his colleagues assessed advanced cancer patients with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Patients underwent nurse-led evaluations at time of admission to assess activities of daily living (ADLs), including mobility, feeding, bathing, dressing, and grooming. Functional impairment was defined as any ADL impairment upon admission. The revised Edmonton Symptom Assessment System (ESAS-r) was used to evaluate physical symptoms, and the Patient Health Questionnaire-4 for psychological symptoms.

Final analysis included 971 patients, of whom 390 (40.2%) had functional impairment. Patients with functional impairment, compared to those without, tended to be older (mean age, 67.18 years vs. 60.81 years) and had a higher physical symptom burden (mean ESAS-r physical score, 35.29 vs. 30.85). A greater proportion of patients with functional impairment versus those without also reported moderate-to-severe pain (74.9% vs. 63.1%) and symptoms of anxiety (38.3% vs. 23.6%) and depression (35.9% vs. 22.4%). Patients with functional impairment had longer hospital length of stay and poorer survival.

The study was published in the June issue of the Journal of the National Comprehensive Cancer Network.

“We are also actively exploring interventions to help patients transition from the inpatient to the outpatient setting, which we have identified as a key challenge for patients with functional impairment,” said senior researcher Ryan D. Nipp, MD, MPH, Mass General Cancer Center. “Future work is needed to develop novel models of care to enhance access to palliative care services and address barriers that limit appropriate access to palliative care among patients with advanced cancer.”