Psychosocial Risk Linked to Increased Readmissions, Length of Stay

Patients undergoing hematopoietic stem cell transplantation (HSCT) with any psychosocial vulnerability appear to be at greater risk for hospital readmission and increased length of stay, according to data recently presented at the American Society of Hematology’s annual meeting.

“Stem cell transplant can be a curative treatment for certain cancers, but it is a very long process that can put strains on a patient before, during, and after the actual transplant,” Ashley Rosko, MD, hematologist at the Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), said in a press release. “Just like we assess potential impact and risks of a patient’s comorbidities before pursuing a stem cell transplant, we saw a need to evaluate psychosocial vulnerabilities to identify those patients at the highest risk for complications and develop interventions to ensure the smoothest recovery possible.”

In the single-center, retrospective, observational study, Dr Rosko and colleagues enrolled 395 HSCT patients who underwent a pre-transplant screening for a number of psychosocial factors, including history of anxiety, depression, and substance abuse. Among these, 48% were determined to be at-risk, with psychiatric conditions (24%), poor health behaviors (16%), and poor coping history (13%) being the most commonly observed psychosocial risk factors.

In a controlled multivariable analysis, the researchers found patients with mild (HR = 1.53; 95% CI, 1.04-2.26) and moderate (HR = 1.88; 95% CI, 1.08-3.29) psychosocial risks more likely to be readmitted within 90 days of HSCT, regardless of disease and HSCT type. Furthermore, multiple myeloma patients with mild psychosocial risk factors had longer length of stay than those determined to be at no psychosocial risk (P = .005). The researchers found no differences in overall survival rates among psychosocial risk groups.

“Hospital readmission in stem cell transplant patients is associated with poor overall survival, increased cost and worse quality of life so it is important that we do all that we can to identify these patients in advance of treatment to help them successfully navigate the treatment process,” Dr Rosko said. “Many of these psychosocial risk factors can be mitigated and managed to the benefit of the patient.” —Dave Muioi