Utilization of Support Services, Emergency Department and Hospitalization in Advanced Cancer Patients with Severe Disease in a Community Cancer Institute (QI809)

Abstract

•Define advanced cancer population and severity of disease.•Describe a model of support service delivery in a community cancer institute.•State the correlation of as-needed support service referral on ED utilization and unplanned hospitalizations in one community cancer center. Patients with advanced cancer are at high risk for emergency department (ED) and hospital utilization, which is distressing and costly. Palliative care consultation and symptom management clinics have been shown to decrease ED and hospital utilization, but the frequency and composition of these interventions is still being delineated. To describe healthcare utilization in patients with advanced cancer with respect to support services provided and severity of disease in a community setting. 157 patients with advanced cancer of pulmonary, gastrointestinal, genitourinary or gynecologic origin diagnosed January-December 2015 were reviewed retrospectively. Descriptive data including demographics, disease characteristics, palliative care consultation, support services utilized, and ED visits/hospitalizations were collected for 12 months, or to date of death. Support services included physician assistant–led symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor. Support service referrals were made based on identified needs. Severe disease was defined as death within 6 months of diagnosis. Patients with severe disease had a mean of 6 ED visits per year, significantly greater than patients with non-severe disease (p < 0.001). Patients with severe disease also had more contacts with support services per year (30.3 vs 9.1, p < 0.001). A palliative care consult was placed in 50% of patients with severe disease, and 23% in patients with non-severe disease (p < 0.001). Patients with advanced cancer have high healthcare utilization in the last 6 months of life. As-needed involvement of support services correlated with severity of disease but did not result in decreased ED utilization or hospitalization. These data suggest that availability of as-needed support services alone is not a reliable strategy to impact unplanned hospitalizations and ED visits. Further research is needed to determine if preemptive or mandatory utilization of support services is sufficient to reduce healthcare utilization.