title: ReCAP: Hospitalizations in Older Adults With Advanced Cancer: The Role of Chemotherapy.
abstract: OBJECTIVE
  Hospital readmissions are often cited as a marker of poor quality of care. Limited data suggest some readmissions may be preventable depending upon definitions and available outpatient support.
  
  
  METHODS
  General criteria to define preventable and not preventable admissions were developed before data collection began. The records of sequential nonsurgical oncology readmissions were reviewed independently by two reviewers. When the reviewers disagreed about assigning admissions as preventable or not preventable, a third reviewer was the tie breaker. The reasons for assigning admissions as preventable or not preventable were analyzed.
  
  
  RESULTS
  Seventy-two readmissions occurring among 69 patients were analyzed. The first two reviewers agreed that 18 (25%) of 72 were preventable and that 29 (40%) of 72 were not. A third reviewer found four of the split 25 cases to be preventable; therefore, the consensus preventability rate was 22 (31%) of 72. The most common causes of preventability were overwhelming symptoms in patients who qualified for hospice but were not participating in hospice and insufficient communication between patients and the care team about symptom burden. The most common reason for assignment of a not preventable admission was a high symptom burden among patients without strong indications for hospice or for whom aggressive outpatient management was inadequate. The median survival after readmission was 72 days.
  
  
  CONCLUSIONS
  A substantial proportion of oncology readmissions could be prevented with better anticipation of symptoms in high-risk ambulatory patients and enhanced communication about symptom burden between patients and physicians before an escalation that leads to an emergency department visit. Managing symptoms in patients who are appropriate for hospice is challenging. Readmission is a marker of poor prognosis.
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Caitriona B
authors: CB
authors: O'Neill
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Coral L
authors: CL
authors: Atoria
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Eileen M
authors: EM
authors: O'Reilly
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Martin C
authors: MC
authors: Henman
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Peter B
authors: PB
authors: Bach
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland elkine@mskcc.org.
authors: Elena B
authors: EB
authors: Elkin
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Caitriona B
authors: CB
authors: O'Neill
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Coral L
authors: CL
authors: Atoria
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Eileen M
authors: EM
authors: O'Reilly
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Martin C
authors: MC
authors: Henman
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland.
authors: Peter B
authors: PB
authors: Bach
authors: Memorial Sloan Kettering Cancer Center, New York, NY; and Trinity College Dublin, Dublin, Ireland elkine@mskcc.org.
authors: Elena B
authors: EB
authors: Elkin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018426:SEER Program