Associations between Symptoms with Healthcare Utilization and Death in Advanced Cancer Patients

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Introduction: There is limited data about assessments that are associated with increased utilization of medical services among advanced oncology patients (AOP). We aimed to identify factors related to healthcare utilization and death in AOP. Methods: AOP at a comprehensive cancer center were enrolled in a Centers for Medicare & Medicaid Innovation program. Participants completed the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy – General (FACT-G) scale. We examined factors associated with palliative care (PC), acute care (AC), emergency room (ER), hospital admissions (HA), and death. Results: In all, 817 AOP were included in these analyses with a median age of 69. They were generally female (58.7%), white (61.4%), stage IV (51.6%), and represented common cancers (31.5% GI, 25.2% thoracic, 14.3% gynecologic). ESAS pain, anxiety, and total score were related to more PC visits (B = 0.31, 95% CI [0.21, 0.40], p < 0.001; B = 0.24 [0.12, 0.36], p < 0.001; and B = 0.038 [0.02, 0.06], p = 0.001, respectively). Total FACT-G score and physical subscale were related to total PC visits (B=-0.021 [-0.037, -0.006], p = 0.008 and B=-0.181 [-0.246, -0.117], p < 0.001, respectively). Lower FACT-G social subscale scores were related to more AC visits (B=-0.03 [-0.53, -0.004], p = 0.024); while, increased tiredness was associated with fewer AC visits (B=-0.039 [-0.073, -0.006], p = 0.023). Higher total ESAS scores were related to death within 30 days (OR = 0.87 [0.76, 0.98], p = 0.027). Conclusions: The ESAS and FACT-G assessments were linked to PC and AC visits, and death. These assessments may be useful for identifying AOPs that would benefit from routine PC.