The inpatient rehabilitation experience of patients with cancer
MetadataShow full item record
Objective : The objective of this dissertation was to describe the types of cancer patients who are referred for inpatient rehabilitation services and to examine the association between risk factors for rehabilitation outcomes including discharge to a non-community setting and discharge with low functional status. In addition, we compared inpatient rehabilitation outcomes between cancer patients and non-cancer patients. Lastly, we identified risk factors for early discharge to an acute care hospital among cancer patients. Methods : Data were utilized from the Uniform Data System for Medical Rehabilitation (UDSMR) database, which is the world's largest non-governmental data repository for rehabilitation outcomes. Patients that were discharged from inpatient rehabilitation facilities (IRFs) between October 2010 and September 2012 were used in the analysis. In chapter three, characteristics and rehabilitation variables for cancer patients were summarized. In chapter four, risk factors for discharge to a non-community setting and low functional status were examined among cancer patients. In chapter five, rehabilitation outcomes for cancer patients were compared to those of non-cancer patients. In chapter six, risk factors for early discharge back to the acute care setting were examined. Results : A wide variety of cancer types were seen in IRFs during the study period and included brain and nervous system cancers (52.9%), digestive cancers (12.0%), bone and joint cancers (8.7%), blood and lymphatic cancers (7.6%), respiratory cancers (7.1%) and other cancers (11.7%). The mean age of the population was 65 years, but there were some statistically significant differences in age between cancer subgroups; patients with digestive, respiratory cancers and other cancers were somewhat older than patients with brain and nervous system cancers (mean ages of 74.3, 71.8 and 69.6, respectively). On average, cancer patients were admitted with a FIM total score of 65.1, were discharged with a FIM total score of 84.7, and, on average, gained approximately 23.5 FIM points over the course of their inpatient rehabilitation episode of care. Patients with each of the cancer types studied made statistically significant and clinically important 1,2 functional improvement from admission to discharge. In addition, the majority (72%) of cancer patients were discharged to a community setting. Patients with blood and lymphatic cancers had the lowest discharge to community setting (62%), which is attributable to their high rate of discharge to the acute care setting (28.4%). Positive predictors for discharge to a non-community setting among all cancer patients included age (OR=1.07, 95% CI: 1.05-1.10), male gender (OR=1.24, 95% CI: 1.16-1.31), not married (OR=1.30, 95% CI: 1.20-1.39), not employed (OR=1.13, 95% CI: 1.02-1.27), living alone prior to admission (OR=1.34, 95% CI: 1.23-1.46) and higher comorbidity tier (tier D OR=1.12, 95% CI: 1.05-1.20). In addition, patients with bone and joint (OR=1.14, 95% CI: 1.00-1.30), blood and lymphatic (OR=1.85, 95% CI: 1.62-2.11) and respiratory cancers (OR=1.19, 95% CI: 1.01-1.40) had a higher likelihood of discharge to a non-community settting. Functional status at admission, (measured by admission FIM total score) was a negative predictor of discharge to a non-community setting; with each one point increase in FIM total score, the odds of discharge to a non-community setting decreased by 4% (OR = 0.96, 95% CI: 0.96-0.96). Risk factors for low functional status at discharge were similar for non-community discharge except for pre-admission living status, which was associated with a reduced odds of low functional status at discharge (OR= 0.81, 95% CI: 0.75-0.89). Patients with brain and nervous system, bone and joint and blood and lymphatic cancers were discharged to a non-community setting more frequently, were more functionally dependent and made less FIM change over their rehabilitation stay than their non-cancer counterparts. However, all cancer patients made clinically meaningful functional gains and most were discharged to a community setting. In addition, functional status at admission was the strongest risk factor for early discharge back to an acute care setting among cancer patients; compared with patients that had complete/modified independence, patients that needed moderate assistance were 2.5 times more likely to be discharged back to the acute care setting within three days (OR=2.51. 95% CI:1.85-3.42); patients with total/maximal assistance at admission were nearly 8 times more likely to be discharge back to the acute care setting within three days (OR=7.76, 95% CI: 5.52-10.90). Conclusion : The findings of this dissertation increase our knowledge about what is known about cancer patients that are referred to inpatient rehabilitation facilities. The results highlight that although cancer patients make clinically significant functional gains over rehabilitation, certain cancer subgroups do not do as well as non-cancer patients receiving inpatient rehabilitation care. Further investigation is needed to determine how tailored rehabilitation interventions can be used. In addition, low functional status at admission was strongly associated with adverse rehabilitation outcomes among cancer patients.