A new algorithm can help predict which cancer patients have a higher risk of visiting the emergency department (ED) or requiring hospitalization, according to research published in the Journal of the National Comprehensive Cancer Network.

Using symptom complexity scores derived from the algorithm can identify patients who should be more closely monitored for additional support, researchers reported.

To create the algorithm, researchers used data from 29,133 cancer patients from a population-based administrative health care database. Cancer types included hematologic (21.0%), breast (20.1%), genitourinary (14.3%), gastrointestinal (12.3%), gynecologic (8.1%), lung (7.7%), and other cancers (16.5%). 


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The patients had completed at least 1 patient-reported outcome (PRO) questionnaire between October 1, 2019, and April 1, 2020. The questionnaire included the Edmonton Symptom Assessment System-Revised (ESAS-r) and Canadian Problem Checklist (CPC). The researchers used the information from the questionnaires to develop the algorithm and assign symptom complexity scores to patients.

Overall, 738 patients (2.5%) had an ED visit within 7 days of completing their PRO questionnaire, and 452 patients (1.6%) were admitted to the hospital within that time period. 

In a multivariate analysis, patients with a high symptom complexity score were significantly more likely to have an ED visit within 7 days, compared with patients who had a low score (odds ratio [OR], 3.10; 95% CI, 2.59-3.70). A moderate symptom complexity score was also associated with an increased likelihood of an ED visit compared with a low score (OR, 1.83; 95% CI, 1.51-2.20).

Similarly, the likelihood of being admitted to the hospital within 7 days of PRO questionnaire completion was significantly higher for patients with a moderate score (OR, 1.92; 95% CI, 1.49-2.47) or high score (OR, 4.20; 95% CI, 3.36-5.26) than for those with a low score.

Other factors associated with an increased risk of an ED visit or hospital admission included rural location, cancer type, and Charlson comorbidity index. Receiving care at a community cancer center or regional cancer center was associated with an increased risk of an ED visit, as was receiving chemotherapy within the last 21 days. Receiving radiation within the last 14 days was associated with an increased risk of hospitalization.

“Given that patients with higher symptom complexity scores were more likely to use acute care, clinicians should monitor these more complex patients closely, because they may benefit from additional support or symptom management in ambulatory settings,” the researchers concluded.

Reference

Watson L, Qi S, Link C, Delure A, Afzal A, Barbera L. Patient-reported symptom complexity and acute care utilization among patients with cancer: A population-based study using a novel symptom complexity algorithm and observational data. J Natl Compr Canc Netw. Published online February 2023. doi:10.6004/jnccn.2022.7087