The impact of inpatient rehabilitation on outcomes for patients with cancer
Background Patients with cancer have challenges around mobility, activities of daily living, and self-care.
Objective To report outcomes of patients who received radiation therapy while on an inpatient rehabilitation facility (IRF).
Methods 61 patients admitted to an IRF with either a primary malignant brain tumor, tumor metastatic to the brain, tumor metastatic to the spine with spinal cord injury, or tumor metastatic to bone. Each patient required radiation therapy. The study notes the outcomes of 69 patients admitted with stroke and 23 patients admitted with a traumatic spinal cord injury. Each patient was offered therapy in accordance with the Center for Medicare and Medicaid Services guidelines. Level of function was assessed using Functional Independence Measure. Outcome measures were improvement in function, functional level at discharge, length of stay, and percent discharged to home.
Results The patients in the cancer group had significant improvement in function. More than 75% of the patients with cancer returned to their homes. The functional level achieved by patients with primary malignancies of the brain or tumors metastatic to the brain was not significantly different than that of patients with stroke. The functional level achieved by patients with cancer metastatic to the spine was not significantly different than that of patients with a traumatic spinal cord injury. The percent of patients with cancer discharged to home was not significantly different than that of patients without cancer.
Limitations The study reports outcomes from only 1 IRF.
Conclusions Comprehensive care that includes radiation and rehabilitation at the IRF level benefits appropriately selected patients with cancer.
Accepted for publication June 12, 2018
Correspondence George Forrest, MD; georgemcv78@gmail.com
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2018;16(3):e138-e144
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0409
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Limitations
This study reports on the experience of only 1 facility. The number of patients in the radiation group is greater than the number of patients in any previous report of people receiving radiation at an IRF, but the statistician does not think it is large enough to allow statistical analysis of covariates such as age, sex, and comorbid conditions. In addition, we did not investigate all of the factors that influence the type of care patients are offered and their LoS, such as hospital policy, insurance coverage, income, and family structure.
Conclusions
Acute care medical units are now challenged to both reduce LoS and reduce the number of patients who are readmitted to the hospital. Rehabilitation units are challenged to maintain census, as government and private payors are shifting patients from acute rehabilitation units to subacute rehabilitation units. We found that patients with cancer who need radiation are a population of patients who are seen by payors as needing to be in a facility with excellent nursing, therapy, and comprehensive physician services. A comprehensive cancer care program within a rehabilitation unit can be a great benefit to the acute care services, the IRF, and, most importantly, patients and their families.
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