Acute Inpatient Cancer Rehabilitation Unit (ACRU) outcomes at an NCI-Comprehensive Cancer Center

Abstract

8149 Background: Cancer rehabilitation is an important but often underutilized treatment in the comprehensive care of the cancer patient. Cancer patients have varying degrees of access to rehabilitation services throughout the country. We report Acute Inpatient Cancer Rehabilitation Unit (ACRU) outcomes at MD Anderson Cancer Center, which is the only NCI-comprehensive cancer center to have an inpatient rehabilitation unit dedicated solely to cancer patients. Methods: We retrospectively reviewed the inpatient medical records of consecutive inpatients admitted to the ACRU from September 2002-August 2003 for the following information: patient age, sex, primary tumor type, rehab diagnoses, length of stay, discharge destination, and payer source. Results: From September 2002-August 2003, the Physical Medicine and Rehabilitation service at MD Anderson had 865 inpatient consultations, 403 of whom were admitted to the ACRU for a total of 4101 days with a mean stay of 10 days. 218 were male (54%). Mean patient age was 61. Admission criteria included medical stability and the ability to tolerate 3 hours a day of therapies. Primary tumors were brain and spine 113 (28%), hematologic 56 (14%), genitourinary 56 (14%), lung 43 (10%), orthopedic 32 (8%), gastrointestinal 24 (6%), breast 20 (5%), head and neck 16 (4%), and other 44 (11%). Distribution of discharges included home 299 (74%), back to primary acute service 81 (20%), ICU 8 (2%), skilled nursing facility 7 (2%), nursing home 7 (2%), long term acute care 2 (<1%), death 1 (<1%). Brain and spine patients commonly had the rehab diagnoses hemiparesis or spinal cord injury. Hematologic patients' rehab diagnoses were more frequently asthenia and dyspnea on exertion. Most patients carried the rehab diagnosis of gait abnormality. Payer source distribution included Medicare 177 (44%), private insurance 145 (36%), HMO 36 (9%), Medicaid 20 (5%), and indigent status 24 (6%), with an overall denial rate of 0%. Conclusions: An active inpatient clinical service possessing a wide variety of tumor types was financially viable and able to successfully discharge to home 74% of its patients. No significant financial relationships to disclose.