eCQ 11-4 Newsletter

Rate of Unplanned Hospitalizations High Among Newly Diagnosed Cancer Patients

planned surgery were excluded. Among all newly diagnosed patients (female, 51.7%; non-Hispanic white race/ethnicity, 61.4%), the most common cancer sites were breast (17.1%), prostate (14.4%), and lung (10.3%). More than one-third of patients were diagnosed with advanced cancer, defined as either stage III (16.4%) or stage IV (21.3%); 21.1% died within one year of diagnosis. At 32.9%, cancer was the most com- mon admitting diagnosis for unplanned hospitalizations. Cancer stage was linked to likelihood of unplanned hospitaliza- tion, with 58.3% of those with stage IV cancer being hospitalized in the year after diagnosis, compared with 21.9% of those with stage I cancer. OVERALL FINDINGS • 62%of newly diagnosed cancer patients had at least one all-cause hospitalization during the year following diagnosis. • 35% of all patients in the cohort experi- enced an unplanned hospitalization, with 67% of their total hospitalizations being unplanned. • 67%of unplanned hospitalizations origi- nated in the ED. PATIENT DATA Unplanned hospitalizations were high- est among those who were: • Aged ≥ 76 years (42.5%) • Of non-Hispanic black race/ethnicity (41.3%) • Not married (40.5%) • Uninsured (47.8%) • In the lowest (42.7%) vs highest (28.6%) socioeconomic-status quintile • Diagnosed with cancers of the brain or central nervous system (58.5%), liver, gallbladder, or pancreas (57.9%), and lung (55.0%). • Diagnosed with stage IV (58.3%) as compared with stage I (21.9%) disease NON-CANCER ADMITTING DIAGNOSES The most common non-cancer admit- ting diagnoses among unplanned hospi-

talizations included: • Infection or fever (15.8%) • Complications of a medical device or medical care (6.5%) • Gastrointestinal (5.8%), cardiovascular (5.8%), and respiratory (4.3%) admitting diagnoses. TYPES OF CANCER Types of cancer with the highest inci- dence of unplanned hospitalization for a non-cancer primary diagnosis included: • Hematologic cancer for an admitting diagnosis of infection or fever (21.0%) • Prostate cancer for cardiovascular hos- pitalizations (11.1%) • Colorectal cancer for complications of a medical device or care (9.9%) and gastrointestinal-related hospitalizations (16.4%) • Lung cancer for respiratory hospitaliza- tions (10.5%) Percentage of ED-originated admis- sions by cancer type: • Lung (78.6%) • Hepatobiliary or pancreatic (75.3%) • Other digestive cancers (73.8%) • Bone and soft tissue (49.1%) The percentage of ED-originated admissions by cancer stage varied from 53.9% for stage I to 75.7% for stage IV. The authors express hope that their find- ings may help guide targeted interventions to reduce unplanned hospitalization rates. “These findings...point to the need for a greater understanding of the predictors of unplanned hospitalizations by cancer type, particularly among sociodemographic subgroups with higher rates of [acute care] use,” they write. • Breast (48.1%) • Thyroid (22.3%)

Approximately two thirds (67%) of all- cause hospitalizations occurring among cancer patients within the year following diagnosis — a period that coincides with active treatment for many patients — are unplanned, with the majority (67%) of these originating in the emergency department (ED), according to a report published in the Journal of Oncology Practice, a journal of the American Soci- ety of Clinical Oncology. “The population burden of unplanned hospitalizations among individuals newly diagnosed with cancer is substantial. Many unplanned hospitalizations origi- nate in the ED and are associated with potentially preventable admission diag- noses,” write the authors. “Reducing po- tentially avoidable cancer hospitalizations remains an important target for improv- ing the quality and reducing the costs of cancer care.” STRATEGIES TO REDUCE ACUTE CARE USE Suggested strategies for reducing pre- ventable cancer-related acute care use include: • Timely outpatient symptommanagement • Enhanced access to urgent care • Early palliative care Hospitalization is a leading contributor to cancer-related healthcare spending, note the authors, with cancer patients more likely than patients with other dis- eases to have longer lengths of stay and higher inpatient costs. Although costs for cancer drugs and imaging continue to rise, hospitalization costs —particularly in the year following diagnosis and in the final year of life — account for more than one- half of cancer patients’ treatment costs. Investigators determined the rates of and reasons for unplanned hospitaliza- tions among a cohort of adults (n = 412,850) newly diagnosed with cancer from 2009 to 2012, using data from the California Cancer Registry linked with inpatient data. Hospitalizations for main- tenance chemotherapy, radiotherapy, or

ADDRESSING PATIENTS’ URGENT CARE NEEDS

Studies have highlighted several effec- tive ways to reduce acute care use, note Continued on Page 3

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Volume 11, Issue 4