How long do patients with advanced cancer survive after discharge to sub-acute rehabilitation?

Abstract

67 Background: Patients with advanced cancer inevitably experience a functional decline diminishing quality of life. Many are admitted to the hospital due to progression of disease and become further deconditioned. Discharge to sub-acute rehabilitation (SAR) to "gain strength" for future anti-cancer therapy is common as participation in more intensive rehab therapy is rarely possible. In this study, we wished to determine the length of survival after discharge to SAR and if factors such as pre-hospitalization ECOG correlated with increased length of survival. Methods: At our 926-bed urban academic center, we performed a retrospective chart review from June 2015 to January 2017 of hospitalized patients with solid cancers who were subsequently discharged to SAR. Patients were excluded if they had surgery, a cerebrovascular event during their hospitalization or no post-hospital oncology follow-up plan. The primary outcome was death. Results: Fifty-six patients were identified (median age 69, range 28-95; 87% African American; 72% female). Forty-seven (86%) had metastatic disease. Forty-seven patients (86%) were deceased as of June 2017. The mean survival from date of discharge was 114 days (SD 122.89, range 1-447). Twenty-eight patients (51%) had a pre-hospitalization ECOG of 1 or 2 and twenty-seven patients (49%) had an ECOG of 3 or 4. Mann-Whitney U correlation was used to test the correlation between ECOG and survival. Patients with an ECOG of 1 or 2 trended to survive longer (156 vs 75 days, p=0.06). Self identified white patients had a statistically significant longer survival post discharge to SAR compared to African Americans (204 vs 104 days, p=0.03). Conclusions: Compared to patients with ECOG 1 or 2, patients with ECOG of 3 or 4 survived for a fewer number of days. The identification of additional markers of poor prognosis through larger prospective multi-institutional studies will help to delineate which patients are more likely to benefit from discharge to SAR.