Abstract P4-12-04: Healthcare utilization and symptoms among hospitalized patients with breast cancer
Bibliographic record
Abstract
Abstract Background: Patients with breast cancer generally receive most of their care in an outpatient setting, but unplanned hospitalizations may occur to help manage uncontrolled symptoms. We sought to investigate healthcare utilization and symptoms among patients with breast cancer experiencing an unplanned hospitalization. Methods: We enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 2/2017. The current study focuses on the patients with breast cancer in this cohort. Following hospital admission, we assessed patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS). We reviewed the electronic health record to obtain information about patient demographics, clinical characteristics, healthcare utilization, and reasons for hospital admission (elicited from primary and secondary diagnoses listed on the hospitalization discharge summary). We examined the associations among patients’ symptoms, healthcare utilization (i.e., hospital length of stay and 90-day readmissions), and survival using regression models. Results: We identified 101 patients with breast cancer (median age=60 years [range 22-86]. In this cohort, 74% had metastatic breast cancer. Primary/secondary reasons for hospitalization included fever/infection (34%), pain (18%), dyspnea (12%), gastrointestinal diagnoses (constipation, diarrhea, bowel obstruction, biliary obstruction, ascites, 10%), nausea/vomiting (7%), failure to thrive (6%), pleural effusion (5%), renal failure (4%), blood clot (3%), cardiac diagnoses (atrial fibrillation, cardiomyopathy, 3%), lightheadedness/hypotension (3%), neurologic diagnoses (altered mental status, seizure, subdural hematoma, 3%), fracture (2%), lower extremity swelling (2%), and other (i.e., rash, ptosis, SVC syndrome, fall, 1% each). Table 1 describes the baseline ESAS symptoms collected upon hospital admission. The mean length of hospital stay was 6.2 days and 90-day readmission rates were 28%. Patient disposition post hospitalization included discharge to home (76%), post-acute care facility (12%), hospice (5%), and death in the hospital (6%). We found that patients’ ESAS-physical symptoms were associated with longer hospital length of stay (B=0.08, p=0.029), greater risk of death or readmission within 90-days (OR=1.07, p<0.001), and worse overall survival (HR=1.04, p=0.001). Similarly, patients’ ESAS-total symptoms were associated with longer hospital length of stay (B=0.07, p=0.013), greater risk of death or readmission within 90-days (OR=1.05, p=0.001), and worse overall survival (HR=1.02, p=0.003). Conclusions: In this cohort of hospitalized patients with breast cancer, the majority had metastatic disease and presented with a high symptom burden. Unplanned admissions in these patients with breast cancer commonly occurred for fever/infection, pain, dyspnea, and gastrointestinal reasons. We identified novel associations among patients’ symptoms upon admission with their hospital length of stay, risk of readmissions/death, and overall survival. These findings highlight the need for timely outpatient interventions that address patient symptoms when seeking to enhance health care utilization and survival outcomes in this population. Table 1.Baseline symptom% of patients with moderate or severe symptomsMedian ESAS scoreTiredness*90%8 (Severe)Pain*78%7 (Severe)Well-being76%5 (Moderate)Drowsiness*71%6 (Moderate)Lack of appetite*68%5 (Moderate)Anxiety61%5 (Moderate)Depression52%4 (Moderate)Nausea*45%2 (Mild)Shortness of breath*45%2 (Mild)Constipation*44%0 (None)Total ESAS scoreMedian score 47 Total ESAS_physical score. . Median score 34*components included in ESAS_physical score Citation Format: Neelima Vidula, Emilia Kaslow-Zieve, Carolyn Qian, Isabel Neckermann, Eva Gaufberg, Charu Vyas, Richard Newcomb, Patrick C Johnson, Daniel Lage, Jennifer Shin, Ryan Nipp. Healthcare utilization and symptoms among hospitalized patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-04.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".