Factors associated with patient-reported outcomes in hospitalized patients with cancer.

Abstract

11116 Background: Utilization of patient reported outcomes (PROs) in the ambulatory setting can help to improve symptom control and clinical outcomes among individuals with cancer. However, little is known about PROs among hospitalized patients with cancer. Methods: We conducted a prospective study to examine PROs among hospitalized patients with cancer at the University of Oklahoma Medical Center from 8/2023 to 9/2024. Within 2-5 days of admission, we asked patients to complete surveys assessing physical symptoms (MD Anderson Symptom Inventory [MDASI]; scored 0-10, higher scores = higher severity/interference), psychological symptoms (PHQ-4; scored 0-12, higher scores = higher distress), coping (Brief COPE; scored 2-8 for each of 14 coping domains), and resilience (Brief Resilience Scale [BRS] scored 1-5, higher scores = higher resiliency). We obtained demographic data and clinical characteristics from the electronic health record, including the Charlson Comorbidity Index (CCI). We used regression models to identify factors associated with PROs. Results: We enrolled 300 of 441 (68.0%) eligible patients (median age = 64.8 years, 43.0% female, 78.0% White, 73.3% with incurable cancer). The most common cancers were hematologic (29.6%), gastrointestinal (20.0%), and gynecologic (17.0%). The mean MDASI severity and MDASI interference scores were 4.20 and 4.77. Symptoms with the highest mean MDASI severity scores were fatigue (6.56), pain (5.87), disturbed sleep (5.77), and drowsiness (5.27). The mean MDASI interference score was highest for normal work (6.45) and general activity (6.45). The mean PHQ-4 score was 4.41, and the mean BRS score was 2.98. Coping measures with the highest mean Brief COPE scores were use of emotional support (6.66), acceptance (6.55), and religion (6.04) coping. Older age at enrollment was associated with lower MDASI severity (B = -0.02, P < .01), venting (B = -0.02, P = .03), and humor coping scores (B = -.02, P < .01), yet higher use of emotional support (B = 0.02, P = .03) and religion coping scores (B = 0.03, P = .01). Female sex was associated with higher MDASI severity (B = 0.65, P < .01), self-distraction coping (B = 0.63, P < .01), and positive reframing coping (B = 0.77, P < .01). Higher CCI was associated with higher substance use coping (B = 0.11, P < .01) and behavioral disengagement (B = 0.10, P = .03). Patients with hematologic malignancy had higher use of self-distraction coping (B = 0.55, P = .02). We found no differences in PROs for curable versus incurable cancer. Conclusions: Hospitalized patients with cancer report high physical and psychological symptoms, with significant associations of PROs with increasing age, female sex, comorbidities, and diagnosis of hematologic malignancy. Our findings highlight the importance of addressing symptom concerns and coping mechanisms in hospitalized patients with cancer, which could inform targeted interventions to enhance PROs and clinical outcomes.