Continuum: A Postdischarge Supportive Care Intervention for Hospitalized Patients With Advanced Cancer

Daniel E Lage; Alane S Burger; Julia Cohn; Max Hernand; Evanna Jin; Nora K Horick; Laurie Miller; Caroline Kuhlman; Elizabeth Krueger; Kara Olivier; Dana Haggett; Erika Meneely; Christine Ritchie; Ryan D Nipp; Lara Traeger; Areej El-Jawahri; Joseph A Greer; Jennifer S Temel

doi:10.1016/j.jpainsymman.2024.08.024

Continuum: A Postdischarge Supportive Care Intervention for Hospitalized Patients With Advanced Cancer

J Pain Symptom Manage. 2024 Aug 27:S0885-3924(24)00958-8. doi: 10.1016/j.jpainsymman.2024.08.024. Online ahead of print.

Authors

Daniel E Lage¹, Alane S Burger², Julia Cohn³, Max Hernand⁴, Evanna Jin⁴, Nora K Horick⁴, Laurie Miller⁴, Caroline Kuhlman⁴, Elizabeth Krueger⁴, Kara Olivier⁴, Dana Haggett⁴, Erika Meneely⁴, Christine Ritchie⁴, Ryan D Nipp⁵, Lara Traeger⁶, Areej El-Jawahri⁷, Joseph A Greer⁷, Jennifer S Temel⁷

Affiliations

¹ Memorial Sloan Kettering Cancer Center (D.E.L.), New York, NY, USA; Massachusetts General Hospital (D.E.L., M.H., E.J., N.K.H., L.M., C.K., E.K., K.O., D.H., E.M., C.R., R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA. Electronic address: laged1@mskcc.org.
² University of Colorado Boulder (A.S.B.), Boulder, CO, USA.
³ Duke University (J.C.), Durham, NC, USA.
⁴ Massachusetts General Hospital (D.E.L., M.H., E.J., N.K.H., L.M., C.K., E.K., K.O., D.H., E.M., C.R., R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA.
⁵ Massachusetts General Hospital (D.E.L., M.H., E.J., N.K.H., L.M., C.K., E.K., K.O., D.H., E.M., C.R., R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA; Harvard Medical School (R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA; Univeristy of Oklahoma (R.D.N.), Oklahoma City, OK, USA.
⁶ Massachusetts General Hospital (D.E.L., M.H., E.J., N.K.H., L.M., C.K., E.K., K.O., D.H., E.M., C.R., R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA; Harvard Medical School (R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA; University of Miami (L.T.), Miami, FL, USA.
⁷ Massachusetts General Hospital (D.E.L., M.H., E.J., N.K.H., L.M., C.K., E.K., K.O., D.H., E.M., C.R., R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA; Harvard Medical School (R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA.

PMID: 39197695
DOI: 10.1016/j.jpainsymman.2024.08.024

Abstract

Context: Patients with advanced cancer are at increased risk for multiple hospitalizations and often have considerable needs postdischarge. Interventions to address patients' needs after transitioning home are lacking.

Objectives: We sought to demonstrate the feasibility and acceptability of a postdischarge intervention for this population.

Methods: We conducted a single-arm pilot trial (n = 54) of a postdischarge intervention, consisting of a video visit with an oncology nurse practitioner (NP) within three days of discharge to address symptoms, medications, hospitalization-related issues, and care coordination. We enrolled English-speaking adults with advanced breast, gastrointestinal, genitourinary, or thoracic cancers experiencing an unplanned hospitalization and preparing for discharge home. The intervention was deemed feasible if ≥70% of approached patients enrolled and ≥70% of enrolled patients completed the intervention within three days of discharge. Two weeks after discharge, patients rated the ease and usefulness of the video technology on a 0-10 scale (higher scores indicate greater ease of use). NPs completed postintervention surveys to assess protocol adherence.

Results: We enrolled 54 of 75 approached patients (77.3%). Of enrolled patients (median age = 65.0 years), 83.3% participated in the intervention within three days of discharge. The median ease of participating in the intervention was 9.0 (IQR: 6.0-10.0) and the median usefulness of the intervention was 7.0 (IQR: 4.5-8.0). The majority of visits focused on symptom management (85.7%), followed by posthospital medical issues (69.0%).

Conclusion: An oncology NP-delivered intervention immediately after hospital discharge is a feasible and acceptable approach to providing postdischarge care for hospitalized patients with advanced cancer.

Keywords: Advanced cancer; intervention; postdischarge; supportive care.