The Lynx Group

Disparities in Rehospitalization Rates Among Patients with Advanced Cancer

November 2016, Vol 7, No 10

San Francisco, CA—In addition to being costly for public and private payers, hospital readmissions can lead to increased risk for complications, hospital-acquired infections, and psychological distress in patients with advanced cancer. Although preventing readmissions would improve patient outcomes and decrease healthcare costs, the underlying causes of rehospitalization are not completely understood, suggested Robin L. Whitney, RN, PhD, Betty Irene Moore School of Nursing, University of California, Davis, and colleagues in a poster presentation at the 2016 Palliative Care in Oncology Symposium.

“Frequent hospitalization is often at odds with patient preference and is increasingly viewed as a hallmark of poor quality care…but patterns and reasons for readmissions are poorly described in the literature,” they noted.

Using data from the California Cancer Registry and hospital claims, Dr Whitney and colleagues found that predictors for rehospitalization in the year after diagnosis with advanced cancer included:

  • Race
  • Socioeconomic status
  • Type of insurance coverage
  • Presence of comorbidities
  • Primary tumor site.

Key Findings

The study included 25,032 patients with colorectal cancer, pancreatic cancer, prostate cancer, breast cancer, or non–small-cell lung cancer (NSCLC) between 2009 and 2012. In the year after diagnosis, 71% of patients with advanced cancer had ≥1 hospitalizations, 16% of patients had ≥3 hospitalizations, and 64% of hospitalizations followed an emergency department visit.

Notable disparities were seen among patients from different races. Compared with non-Hispanic whites, rehospitalization rates were significantly higher for non-Hispanic blacks, Hispanics, and Asian/Pacific Islanders.

Patients in the lowest socioeconomic-status quintile were also significantly more likely to be readmitted in the year after diagnosis compared with patients in the highest socioeconomic-status quintile.

Rehospitalization rates were higher for individuals with public or no insurance compared with those with private insurance. In addition, patients with pancreatic cancer or NSCLC had higher hospitalization rates compared with patients with colorectal cancer.

Not surprisingly, the presence of multiple comorbidities correlated with greater probability of rehospitalization.

Finally, palliative care had a mitigating effect. According to Dr Whitney, rehospitalization rates were significantly lower after discharge from a hospital with an outpatient palliative care program.

“Efforts to reduce hospitalization and provide care congruent with patient preferences might focus on improving access to outpatient palliative care, particularly among subgroups at greater risk, including racial and ethnic minority groups, and those with a lower socioeconomic status, comorbidities, and pancreatic cancer or NSCLC,” Dr Whitney and colleagues concluded.

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