Determination of factors associated with hospitalization in breast cancer survivors.

PURPOSE/OBJECTIVES To identify factors associated with hospitalization after diagnosis of breast cancer in working-age women. DESIGN Descriptive, retrospective survey. SETTING Caseload of a single medical oncologist affiliated with an urban, not-for-profit, academic medical center. SAMPLE 123 consecutively evaluated women aged 21-65 years with breast cancer associated with projected survival greater than three years. METHODS Data were collected from an electronic clinical file with demographic, diagnostic, and hormone replacement therapy (HRT) information. Four survey forms were mailed to subjects: (a) a form ascertaining personal demographics, health status, and healthcare utilization, (b) menopausal Symptom Rating Scale, (c) a hot flash diary, and (d) the Center for Epidemiologic Studies Depression Scale. MAIN RESEARCH VARIABLES Menopausal symptoms, depression symptoms, age, time since diagnosis, and overnight hospitalization. FINDINGS An increasing depression score and increasing menopausal symptoms score were found to be independent predictors of hospitalization controlling for age at diagnosis, disease stage, and time since diagnosis. Demographic variables, HRT use at or prior to diagnosis (a proxy measure of health status), current self-reported health status, and hot flashes were not associated with hospitalization. CONCLUSIONS Psychological factors can be important significant predictors of hospitalization in survivors of breast cancer independent of disease stage. Further study should be undertaken to determine whether support services directed at identifying and treating those at risk for depression or menopausal symptoms may reduce the likelihood of potentially avoidable hospitalization. IMPLICATIONS FOR NURSING The identification of those at high risk for hospitalization because of high levels of depressive or menopausal symptoms and prompt intervention offer the opportunity to improve the quality of life of breast cancer survivors and reduce the cost of health care for themselves, their families, and the healthcare system.