Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.

Abstract

2013 Background: Hospitalized patients with cancer often experience high symptom burden, which may impact their care satisfaction and use of health care services. Yet, studies describing these patients’ care satisfaction, symptom burden, and health care utilization are lacking. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014-4/2017. Upon admission, patients self-reported their care satisfaction (FAMCARE items asking about satisfaction regarding speed with which symptoms are treated and coordination of care) and physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ4]) symptom burden. We used regression models to identify patient factors associated with care satisfaction. We also explored associations between patients’ care satisfaction, symptom burden, and hospital length of stay (LOS) in models adjusted for age, sex, marital status, comorbidity score, cancer type, cancer documented as curable/incurable, time since cancer diagnosis, and admission to a dedicated oncology service. Results: We enrolled 1,576 of 1,749 (90.1%) consecutive patients (mean age = 63.19±13.39 years, 46.3% female). Most reported being very satisfied/satisfied with the speed with which symptoms are treated (89.0%) and coordination of care (90.1%). Older age (B = 0.01, P < .02 for both) and admission to a dedicated oncology service (B = 0.20, P < .01 for both) were each independently associated with higher satisfaction with the speed with which symptoms are treated and coordination of care. Higher satisfaction with the speed with which symptoms are treated was associated with lower PHQ4 depression (B = -0.14, P = .01), PHQ4 anxiety (B = -0.11, P < .01), ESAS physical (B = -1.30, P < .01), and ESAS total (B = -2.44, P < .01) symptoms. Higher satisfaction with coordination of care was associated with lower PHQ4 depression (B = -0.14, P = .02), PHQ4 anxiety (B = -0.16, P < .01), ESAS physical (B = -1.30, P < .01), and ESAS total (B = -2.75, P < .01) symptoms. Satisfaction with the speed with which symptoms are treated (B = -0.47, P = .03) and coordination of care (B = -0.50, P = .03) were both associated with shorter hospital LOS. Conclusions: Most hospitalized patients with cancer reported high care satisfaction, which was associated with older age and admission to a dedicated oncology service. We found relationships among higher care satisfaction, lower symptom burden, and shorter hospital LOS, underscoring the importance of efforts to enhance symptom management and care coordination in this population.