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Reduce Unplanned Hospitalizations of Your Cancer Patients

By Christopher Cheney  
   February 11, 2019

For many cancer patients, the causes of unanticipated hospital stays in the first year after receiving a diagnosis are unrelated to cancer, such as infection.

Many unplanned hospitalizations of cancer patients could be avoided, recent research indicates.

Hospitalization is a leading contributor to cancer-related healthcare spending. Hospitalizations for cancer involve longer length of stay and higher costs than inpatient care for other conditions.

The lead author of the recent research, which was published in Journal of Oncology Practice, told HealthLeaders there are opportunities to avert many unplanned hospitalizations of cancer patients.

"We know that many individuals undergoing treatment for cancer will experience treatment-related symptoms and side effects. Improving symptom management and enhancing access to care such as same-day and after-hours support are promising approaches because they can provide patients with help for distressing symptoms when they need it," said Robin Whitney, PhD, RN.

The researchers found that 35% of cancer patients had an unplanned hospitalization within a year after receiving their diagnosis. Patients who are frail or entering advanced stages of disease could be the most promising focal point in efforts to reduce unplanned hospitalizations, said Whitney, director of research at the Hillblom Center on Aging, and an assistant adjunct professor at UCSF Fresno Medical Education Program in Fresno, California.

"There is evidence that many potentially avoidable hospitalizations in oncology occur among individuals who are already frail, have multiple concurrent health conditions, or who have advanced cancers that are not amenable to treatment. Focusing efforts on individuals who are at high risk of experiencing complications may be the most promising approach. These individuals should receive palliative and supportive care services to address their needs, concurrently with active treatment."

Unplanned hospitalization data

The Whitney team's research, which features data from more than 421,000 patients, generated several key data points for unplanned hospitalizations of cancer patients.

  • In the year after diagnosis, about 67% of hospitalizations were unplanned
  • At 32.9%, cancer was the most common diagnosis listed for unplanned hospitalization
  • Noncancer diagnoses listed for unplanned hospitalizations included infection or fever (15.8%), medical device (6.5%), gastrointestinal (5.8%), cardiovascular (5.8%), and respiratory (4.3%)
  • Stage of cancer at time of diagnosis was linked to likelihood of unplanned hospitalization, with 21.9% of stage I patients experiencing an unplanned hospitalization compared to 58.3% of stage IV patients
  • About 67% of unplanned hospitalizations originated in the emergency department

An urgent care strategy can decrease unplanned hospitalizations and emergency room visits, Whitney said.

"Some oncology programs have been able to successfully reduce ER visits and unplanned hospitalizations by improving their ability to address the urgent care needs of their patients. For example, some have implemented workflows for oncology nurses to triage patient symptoms and facilitate same day appointments when needed. Others have had success using navigators who can provide additional support and connect patients and caregivers with community resources."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


For cancer-related healthcare spending, hospitalization is the primary cost contributor.

Researchers found that 35% of cancer patients had an unplanned hospitalization within a year after receiving their diagnosis.

Strategies to avert unplanned hospitalizations include improving symptom management and boosting access to urgent-care services.

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