Characterization of Cancer Patients in Inpatient Rehabilitation Facilities: A Retrospective Cohort Study

Abstract

Objectives To identify the types of cancer patients admitted to inpatient medical rehabilitation and to describe their rehabilitation outcomes. Design: Retrospective cohort study. Setting U.S. inpatient rehabilitation facilities (IRFs). Participants Adult patients (N=27,952) with a malignant cancer diagnosis admitted to an IRF with a cancer-related impairment between October 2010 and September 2012 were identified from the Uniform Data System for Medical Rehabilitation database. Interventions Not applicable. Main Outcome Measures Demographic, medical, and rehabilitation characteristics for patients with various cancer tumor types were summarized using data collected from the Inpatient Rehabilitation Facility–Patient Assessment Instrument. Rehabilitation outcomes included the percentage of patients discharged to the community and acute care settings, and functional change from admission to discharge. Functional status was measured using the FIM instrument. Results Cancer patients constituted about 2.4% of the total IRF patient population. Cancer types included brain and nervous system (52.9%), digestive (12.0%), bone and joint (8.7%), blood and lymphatic (7.6%), respiratory (7.1%), and other (11.7%). Overall, 72% were discharged to a community setting, and 16.5% were discharged back to acute care. Patients with blood and lymphatic cancers had the highest frequency of discharge back to acute care (28%). On average, all cancer patient groups made significant functional gains during their IRF stay (mean FIM total change ± SD, 23.5±16.2). Conclusions In a database representing approximately 70% of all U.S. patients in IRFs, we found that patients with a variety of cancer types are admitted to inpatient rehabilitation. Most cancer patients admitted to IRFs were discharged to a community setting and, on average, improved their function. Future research is warranted to understand the referral patterns of admission to postacute care rehabilitation and to identify factors that are associated with rehabilitation benefit in order to inform the establishment of appropriate care protocols.

Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease

“…Among brain tumor acute rehabilitation inpatients, return to the primary acute care service rates have been reported between 7.5% and 14.9% . The return to primary acute care service percentage in our LMD group was considerably higher (9/30 or 30%).…”

“…[16][17][18][19][20] Among brain tumor acute rehabilitation inpatients, return to the primary acute care service rates have been reported between 7.5% and 14.9%. 16,21,22 The return to primary acute care service percentage in our LMD group was considerably higher (9/30 or 30%). However, our LMD study was heavily represented by hematologic malignancies (25/30) and is more consistent with their reported return to the primary acute care service rates of between 26% and 38%.…”

A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence‐Based Outcomes

“…Acute inpatient rehabilitation (IRF) has been shown in a number of studies to demonstrate statistically significant improvements in functional scores, including general cancer [19‐27], asthenia/deconditioning [8], brain tumor [28‐32], hemipelvectomy for sarcoma [33], oncologic spinal cord injury [34‐36], and paraneoplastic populations [37]. In the IRF setting, the mean length of stay of patients with cancer has been found to be shorter than their cohorts without cancer, including spinal cord injury [38,39] and brain injury [40‐42] comparison studies.…”

“…Alam et al [61] reported a statistically significant difference of unplanned transfers back to the primary acute care service of 21% of patients with cancer in the IRF versus 9.7% of noncancer‐matched controls. Other studies have reported return to the primary acute care service rates of IRF patients with general cancers between 16.5% and 35% [9,20,21,66‐68]. In most cases, an uninterrupted acute inpatient rehabilitation course with discharge home is considered a successful IRF admission [69,70].…”

Cultural Factors in Ethics Consultations

“…Mr Zhang has not begun radiation or chemotherapy, so the craniotomy and pathology were likely completed recently. The median survival for GBM is 10‐14 months from the time of diagnosis [4]. Therefore, although death is very possible in the next 6‐18 months, it is likely not imminent.…”