Johns Hopkins University, Baltimore, MD
Isaac Martin Bromberg, Louise Knight, Sydney Morss Dy
Background: Patients with advanced cancer suffer acute declines in their functional status for a variety of reasons, including progression of disease, adverse effects of medical or surgical treatment, and exacerbation of a chronic non-cancer condition. The use of rehabilitation services to improve functional status for patients with advanced cancer has been increasing, but the likelihood that a patient will achieve the goals of continued cancer treatment or extended survival has not yet been demonstrated. Times of transition in a patient’s course of illness present opportunities for discussion of goals of care. Methods: The objective of this study was to determine how often patients who were referred to acute rehabilitation (AR) returned to the cancer center for further chemotherapy. A secondary end-point was length of survival after referral. Records of patients admitted to the medical oncology service of an academic cancer center who were referred to AR between January 1, and December 31, 2012, were retrospectively reviewed for the following information: age, gender, race, primary malignancy type, subsequent chemotherapy, and date of death. Results: A total of 43 individual patients were referred for AR. Of these, 22 (51.2%) were 65 years of age or older, 30 (69.8%) were male, 32 (74.4%) were of white race. Primary hematologic malignancies accounted for 26 (60.5%) of the patients, 12 (27.9%) had non-brain solid primary tumors, and 5 (11.6%) had a primary brain tumor. For the 43 patients who qualified for AR, 33 (76.7%) were transferred to an AR facility, 9 (20.9%) were discharged to home, and 1 (2.3%) died in the hospital prior to discharge. Of those 33 patients who went to AR, 17 (51.5%) received further chemotherapy. Of note, 18 (54.5%) of the patients referred to AR died within 6 months (range 17-158 days), and 22 (66.6%) died within one year. Conclusions: Furthercancer treatment after an acute rehabilitation admission is a reasonable goal for patients with advanced cancer; however, these patients frequently have a limited life expectancy and should be considered for palliative care consultation prior to discharge to ensure a discussion about goals of care, in light of their overall prognosis.
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