Race, Socioeconomic Status Linked to Rehospitalizations Among Patients With Advanced Cancer

A new study finds that individuals with advanced cancer have high rates of hospitalization in the year after diagnosis. Palliative care aimed at preventing hospital admissions may be a useful tool, especially for the populations most at risk of rehospitalization.

The research, published in the Journal of Clinical Oncology, notes that hospitalizations are responsible for worsened quality of life and increased costs among patients with advanced cancer. Oncology guidelines now encourage the use of palliative care to avoid hospital admissions, but they still occur. The current study aimed to quantify the impact of patient and hospital characteristics on rehospitalization rates.

Using a population-based cancer surveillance database linked to patient discharge information, the researchers identified more than 25,000 adults with advanced cancer who constituted the study sample. They determined that 71% had at least 1 hospitalization in the year after diagnosis, and 16.1% had 3 or more, totaling 34,394 hospitalizations at 361 California hospitals. Nearly two-thirds of these had originated in the emergency department.

At the hospital level, predictors of readmissions included for-profit status and availability of outpatient palliative care programs. Rehospitalization rates were 33% greater for those discharged from a for-profit hospital compared with discharge from a public hospital. Being discharged from a hospital with a palliative care program was associated with 10% lower readmission rates than those discharged from hospitals without such programs.

The researchers also found several patient-level characteristics that were associated with higher or lower odds of rehospitalization. Women had an 8% lower readmission rate than men, and likelihood of readmission increased with the number of comorbidities present. Black or Hispanic race/ethnicity was associated with increased readmission rates, as was having public insurance or being uninsured. In terms of age and socioeconomic status, the youngest cohort (aged 18-35) and the lowest socioeconomic status quintile had the highest readmission rates.

These findings were consistent with previous research, the authors noted, except that one prior study had found an association between older age and more aggressive end-of-life care. They confirmed that the lower hospitalization rates seen among older patients in this study were not explained by differences in mortality and may instead be evidence of earlier palliative care and hospice services in these individuals.

Indeed, the researchers wrote, palliative care could be key in avoiding the burden of admission and readmission among patients with advanced cancer. Future initiatives could target the populations identified as higher-risk in this study, like men, racial/ethnic minorities, public insurance beneficiaries, and younger patients.

“Policy efforts might include improvements in access to outpatient palliative care and tests of payment models that reduce financial incentives to provide care in the inpatient setting,” the study concluded.