Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients With Advanced Cancer

Abstract

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.

Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

“…Existence of edema might also be associated with the progress of anxiety affecting changes of their body images, causing heaviness and disability in daily living as well. This result is consistent with those obtained from an earlier study investigating the association of functional impairment with anxiety 46 . No relation was found between these two factors and the anxiety of their family members.…”

Representation and Outcomes of Older Adults in Practice-Changing Oncology Trials in the Era of Novel Therapies: A Guideline Appraisal

“…8,60 In addition, other relevant patient-centered issues to consider assessing in future cancer clinical trials include long-term functional outcomes, financial toxicity, and other patient-reported outcomes. 61,62 The representation of older adults in practice-changing trials in our study was higher than previously reported for cooperative group trials and other analyses, which have generally reported representation of older adults as being between 25% and 35%. 2,4,6 The trials included in our study, given their practice-changing nature and largely industrybased funding, may have attracted or recruited a different population and may have been more appealing to older adults.…”

Relationships between prolonged physical and social isolation during the COVID-19 pandemic, reduced physical activity and disability in activities of daily living among people with advanced respiratory disease

“…97 (48%) participants were fully independent in basic ADLs, and 59 (29%) were fully independent in instrumental ADLs. 197 (96%) participants had difficulty managing daily activities (median [IQR]) including those fully independent in basic ADLs (48 [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]) or instrumental ADLs (43 [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]) (Figure 3). Only 10% and 5% of participants received physiotherapy or occupational therapy interventions, respectively, within the last month.…”

“…48 Consequently, physical and social isolation and reduced rehabilitation threatens a post-COVID-19 wave of disability in people with advanced respiratory disease. Addressing disability is important as it is known to lead to increased hospital stay and discharge to a care facility, 49 putting increased strain on already stretched health-and social-care services. Moving forward, health-and social-care services need to consider post-COVID-19 recovery and rehabilitation for all people deemed extremely clinically vulnerable.…”