New research from Mass General Cancer Center, published in JNCCN—Journal of the National Comprehensive Cancer Network, found 40.2% of hospitalized patients with advanced, incurable cancer were functionally impaired at the time of admission, meaning they needed assistance with activities of daily living like walking, bathing, getting dressed, or other routine tasks.
Patients with functional impairment also had higher rates of pain, depression, and anxiety, and were more likely to have longer hospital stays and worse survival.
“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,” lead researcher Daniel E. Lage, of Mass General Cancer Center, said in a statement. “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.”
“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,” senior researcher Ryan D. Nipp, of Mass General Cancer Center, said in a statement.
The researchers studied 970 patients ages 18-and-older with advanced cancer—defined as those not being treated with curative intent—who experienced an unplanned hospital admission at Mass General Cancer Center between Sept. 2, 2014 and March 31, 2016. They measured functional impairment using nursing documentation collected at intake and stored in electronic health records, and also collected self-completed questionnaires from the patients. ADL impairment was defined as any need for assistance by another person. Overall, 390 patients (40.2%) had at least one ADL impairment with 14.8% having one or two, and 25.4% experiencing at least three areas of difficulty with daily tasks.
“Lage and colleagues highlight the important, often-missed, opportunity to routinely use hospitalization as a trigger for a careful assessment of symptoms and functional status,” Toby Campbell, MD, Chief of Palliative Care at the University of Wisconsin Carbone Cancer Center, and a member of the NCCN Guidelines Panel for Palliative Care, said in a statement.
“An unplanned hospitalization for an advanced cancer patient is a watershed moment and predicts higher symptoms and shorter survival in patients with and without impaired function. Hospitalization is a crucial opportunity to facilitate critical serious illness care, including comprehensive palliative care and advanced care planning, with the promise of improving the lives of our patients,” Campbell said.
