Daniel Lage, MD, MSc, Massachusetts General Hospital and Dana Farber Cancer Institute, Boston, MA, discusses results from study exploring symptom burden, functional status, and health care utilization among hospitalized patients with advanced genitourinary cancers.

These results were presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.

Transcript

Hi, I'm Daniel Lage. I'm a medical oncology fellow at the Massachusetts General Hospital and Dana Farber Cancer Institute in Boston, Massachusetts. I'm very happy to talk today about our work on symptom burden, functional status, and clinical outcomes of hospitalized patients with advanced genitourinary cancers.

This research really came about because a lot of the supportive care research and health services research in genitourinary oncology is focused on patients with early-stage curable cancers and patients at other stages of their disease, but there hasn't been a lot of work on patients with advanced cancer and specifically those who are hospitalized with advanced cancer.

What we did in this study is we prospectively enrolled patients with advanced cancer who had unplanned hospitalizations at our medical center, Massachusetts General Hospital. On admission, we asked patients to self-report their physical symptoms, psychological symptoms like depression and anxiety.

We collected assessments of their functional status, impairment in their activities of daily living, and then we looked at a host of clinical outcomes of these patients—length of stay, readmissions, and their overall survival and discharge location.

What we did is we looked at patients with GU cancers, vs all of the other patients with gastrointestinal, lung, or other types of cancer. We also looked within GU cancers, because they're quite different actually at prostate cancer vs kidney, bladder, and adrenal cancer, and separated those out. We looked at outcomes based on that.

In total, we had about 970 patients enrolled. Of which, 106 had advanced GU cancers. Of those 100 patients, 39% were prostate cancer, with the rest being evenly divided between kidney and bladder cancer, so a mix of 30, 40 patients of each type of cancer.

Comparing other cancer types to patients with GU cancers, those with GU cancers were older, median age of 69 vs 64, and they had more time since they were diagnosed with advanced cancer, 14 months vs 7 months, which is expected with the long survival of patients with metastatic prostate cancer.

We found that patients with GU cancers compared to other patients had more impairment in their activities of daily living. Actually, 57% of them had some impairment in their function compared to 38% of other patients.

However, we found that the physical and psychological symptoms measured through these validated scales were pretty similar between patients with GU and non-GU cancers. Now, in separate work that our group has done, we've shown that just overall the symptom burden's very high in this population.

Over 50% experienced moderate to severe pain, lack of appetite, fatigue. About a quarter to a third experienced clinically significant symptoms of depression or anxiety. This is a very symptomatic population.

Now, in multivariable models, patients with GU cancers actually had inferior survival compared to patients with other cancers. After discharge, the median survival of patients with GU cancers was about 102 days vs 133 days for those with other cancers. That was significant on multivariable analysis.

Digging deeper into GU cancers, and looking at kidney, bladder, adrenal vs prostate, as expected, those with prostate were much older. Median age was 74 vs 66 for kidney, bladder, adrenal. Kidney, bladder, adrenal folks had less time since they were diagnosed with their advanced cancer, 9 months vs 23 months.

The symptoms and functional impairment were similar between both groups. An interesting analysis we did was looking at why were these patients admitted in the first place? What was the unplanned issue that led to their admission?

It seems like two-thirds of patients with kidney, bladder, and adrenal cancer are admitted for symptom management. It was some sort of symptom like pain or nausea, etc. that led to their admission, whereas most patients with prostate cancer were admitted for things like failure to thrive, fatigue, and functional issues, which is interesting.

Those are very different types of issues for those patients to have. Then we also found that patients with kidney, bladder, and adrenal cancer had twice the hazard ratio for readmission compared to patients with prostate cancer.

I think, in summary, what we found was that there's a unique profile of patients with GU cancers that are admitted to the hospital, that they have more functional impairment and worse survival compared to patients with other cancers. They're a particularly high-risk group.

Interestingly, within GU cancers, we really honed in on the fact that kidney and bladder cancer patients really have a lot of symptoms. They do get hospitalized for these symptoms, and they get readmitted a lot for these symptoms.

The direction our group is looking at is thinking about what are ways we could actually better support these patients with kidney and bladder cancer, maybe to prevent the admission in the first place by better outpatient palliative care and management? When they're in the hospital, how can we help them transition back home so that they don't get readmitted as much?

Currently, we're very interested in readmission reduction programs, things like care transition interventions with telehealth to help patients when they go home and just help patients transition from hospital to home. Symptom management is a huge part of that. In the study, we saw that, really, for kidney and bladder patients, that's a huge part of it.

For prostate cancer patients, I think the functional impairment, the failure to thrive, shows that when a prostate cancer patient with a median time of 23 months living with their cancer gets admitted, that is a sign really that maybe they're transitioning to a more end-of-life situation.

I think that's another area to intervene on the functional impairment of patients with prostate cancer, the reasons they have failure to thrive and get admitted, and then hopefully, better supporting them with palliative care or other support interventions.

Again, I hope that this study stimulates some thought into healthcare delivery for patients with advanced GU cancers, both in the outpatient, inpatient, and then in the transition back to home, and then also the transition to hospice and supportive care. Thank you. 

Lage DE, Michaelson MD, Sweeney C. Symptom burden, functional status, and clinical outcomes of hospitalized patients with advanced genitourinary cancers. Presented at: the virtual 2021 ASCO Genitourinary Cancers Symposium; February 11-13, 2021. Abstract 42. 

Dr Lage reports reports no relevant financial relationships.