ONCOLOGY NURSING FORUM • VOL. 44, NO. 2, MARCH 2017 177
born, How, Doty, & Peugh, 2009). Hospital stays are
stressful and inconvenient for patients and their fam-
ilies, and substantially contribute to out-of-pocket
healthcare costs. One aim of the Patient Protection
and Affordable Care Act is to reduce healthcare
spending through improved outpatient management
of chronic disease and reduced hospital readmis-
sions (Carroll & Frakt, 2013; Kocher & Adashi, 2011).
Likewise, the Center for Medicaid and Medicare
Innovation instituted a five-year Community Care
Transitions Program to test models for improving
patient transitions from hospitals to other settings
and avoiding unnecessary readmissions (Agency
for Healthcare Research and Quality [AHRQ], 2014;
Kocher & Adashi, 2011). Such initiatives are built on
the assumption that some readmissions are prevent-
able; the validity of readmission rates as indicators
of healthcare quality depends on this premise (Gold-
field et al., 2008).
Oncology nurses play important roles in prevent-
ing readmission from the moment patients are ad-
mitted to hospitals by identifying and addressing
complications and adverse inpatient events that
may increase readmission risk, assessing patient and
family knowledge, providing education throughout
the hospital stay and in preparation for discharge,
assisting with medication management, support-
ing advanced care planning, and coordinating care
transitions between inpatient and community-based
providers and services (Feigenbaum et al., 2012;
Naylor et al., 2011). Indeed, a growing body of evi-
dence suggests that multicomponent interventions
focused on care transitions and incorporations of
strategies—such as comprehensive discharge plan-
ning and instructions with follow-up, home visits,
individualized care planning, clinical management,
education, and behavioral support—may be effec-
tive in reducing readmission rates (Coleman, Parry,
Chalmers, & Min, 2006; Epstein, Jha, & Orav, 2011;
Feigenbaum et al., 2012; Hansen, Young, Hinami,
Leung, & Williams, 2011; Hari & Rosenzweig, 2012;
Jack et al., 2009; Naylor et al., 2011; Peikes, Chen,
Schore, & Brown, 2009; VanSuch, Naessens, Stroebel,
Huddleston, & Williams, 2006).
Successful nursing interventions to reduce re-
admission depend on identifying groups at risk for
preventable readmission; however, the burden of
readmissions for patients with cancer is not well
described in extant literature, nor is the extent to
which readmissions are preventable in this popula-
tion. To date, cancer-specific readmission rates are
not publicly reported, and the Centers for Medicare
and Medicaid Services (CMS) penalties for readmis-
sions do not apply to cancer hospitals (Horwitz et
al., 2012). In a predictive model of avoidable read-
missions developed at a large academic medical
center (Donzé, Aujesky, Williams, & Schnipper, 2013),
discharge from an oncology service was a significant
risk factor, even when excluding planned readmis-
sions for chemotherapy. Similarly, a Canadian study
(Ji, Abushomar, Chen, Qian, & Gerson, 2012) found
that the all-cause readmission rates of patients with
cancer were higher than the rates of patients with
other conditions. Whether these findings are relevant
to the unique U.S. clinical, payment, and healthcare
policy environment is unknown.
Studies of readmissions among patients with cancer
in the United States are needed to ascertain the extent
of this population’s risk for readmission, to identify
subgroups that might benefit from interventions to
reduce readmissions, and to provide benchmarks
against which to measure the success of such
interventions. Accordingly, this systematic literature
review had three related aims focused on patients
with cancer: (a) to examine the proportion of patients
with cancer who are readmitted to the hospital within
30 days of discharge, (b) to enumerate the reasons
for and predictors of readmissions, and (c) to assess
whether and how current studies identify potentially
preventable readmissions.
Methods
Following the Preferred Reporting Items for System-
atic Reviews and Meta-Analyses (PRISMA) guidelines
(Moher, Liberati, Tetzlaff, & Altman, 2009), the authors
of the current study searched three electronic library
databases (PubMed, CINAHL®, EconLit) and the online
bibliography of the National Cancer Institute’s Surveil-
lance Epidemiology and End Results (SEER) Program.
The Medical Subject Heading (MeSH) terms patient
readmission and neoplasms or neoplasm metastasis
or carcinoma were employed in the PubMed search.
The keywords readmission(s) or rehospitalization(s)
were used in the EconLit search, which was limited
to publications in analysis of healthcare markets,
health, government policy, regulation, public health,
and health production. The subject headings readmis-
sion and neoplasms were employed in the CINAHL
search. The SEER bibliography search focused on
the keywords readmission(s) or rehospitalization(s) in
abstracts and titles. In addition, the authors identified
relevant articles outside the database and bibliogra-
phy searches.
Inclusion and Exclusion Criteria
The inclusion criteria included (a) peer-reviewed
empirical studies conducted in the United States, (b)
articles published from January 1, 2005, to Decem-
ber 31, 2015, (c) articles with sample sizes of 50 or

A Systematic Review of Hospital Readmissions Among Patients With Cancer

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