The hospitalist-led model for delivering acute care to solid tumor patients has been adapted in many cancer institutions across the United States. In this study on the perspectives of the hospitalists and the oncologists on inpatient solid tumor cancer care, there were some areas of agreement but perspectives from the hospitalists and oncologists were also noted to differ on some pertinent issues.
Though most of our hospitalists (65%) and oncologists (83%) believed that solid tumor patients should be admitted to an oncology-led service, several studies have shown that a hospitalist-led service may have better outcomes and may allow oncologist to spend their time more efficiently.3
The oncologists and the hospitalists held differing views on the aspect of communication, particularly about “Notifying the oncologist” and “Being guided with inpatient care.”
The hospitalists were largely not satisfied with the level of involvement of the oncologist with their inpatients and wanted more input. Improved patient safety and efficient care by the hospitalist has been shown to be impacted by communication between the two services, and the implementation of a standardized handoff from the oncologist to the hospitalist has been shown to lead to improved communication between both services and subsequently improved patient care.5 Manzano1 also showed that seamless communication between the two physician groups was necessary to ensure that the process of assigning patients was proper and efficient, and to ensure optimal patient handoffs.
The vast majority of both the oncologists and the hospitalists agreed that the discussion of tumor/chemotherapy status and disease activity should be directly communicated by the oncologist.
Since most oncologists indicated that solid tumor patients should be managed by an oncology-led service rather than a hospitalist-led service, it would be very insightful if we could have both services concurrently and measure and compare the metrics for length of stay, complications, mortality, readmission rates, transition to hospice care, and physician and patient satisfaction.
The overwhelming majority of hospitalists reported that the solid tumor patients admitted to their service should have been in palliative/hospice care, and this is supported by the fact that most -oncologists reported transitioning these patients to hospice care in the in-patient setting. Increased discussions with the Oncologists and their patients on end-of-life issues and involving palliative care would potentially reduce these admissions numbers significantly. Most of these patients would not seek emergent in-patient care, but comfort/hospice care. This is imperative as studies have shown that high unplanned readmission rates in advanced cancer patients that are related to complications of the cancer would be reduced if patients are transitioned by their oncologist to palliative care.6 Furthermore, it was shown that cancer patients with advanced disease who discuss end of life issues and understand their prognosis are less likely to receive life sustaining interventions and admissions by the hospitalist and have a better quality of life.7
Most hospitalists in this study did not find the experience of taking care of solid tumor patients to be positive. This is likely multifactorial in nature. First, most hospitalists did not feel fully supported by the oncologist with their solid tumor, acutely ill patients. Second, most hospitalists reported that the solid tumor patients admitted to their service should be in palliative/hospice care. Third, the hospitalists in this study had significantly fewer years of clinical experience than the oncologists.
This study has limitations. This study was conducted within one health system. We thus cannot assume our results have generalizability and applicability to other health systems.