Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Effective selection of patients with solid-organ malignancies for in-patient rehabilitation: analysis of cancer patients referred to Nepean Rehabilitation services between 2018-2020 (#213)

Vikram Joshi 1 , Michael Que 2 , Sharon Wong 1 , Laurence Chu 1 , Deme Karikios 2 3 , Alexander Murphy 3
  1. Department of Rehabilitation Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Kingswood, New South Wales, Australia
  2. Nepean Clinical School, Faculty of Medicine and Health, University of Sydney , Kingswood, NSW, Australia
  3. Nepean Cancer & Wellness Centre, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia

Background:

Cancer survivorship is characterised by increasing complexity of impairments related to disease and treatment side effects. Access to inpatient rehabilitation resources remains limited. We evaluated clinical factors that may help prognosticate successful rehabilitation outcomes.

Methods:

Retrospective review of adult patients referred to rehabilitation at Nepean Hospital with solid-organ malignancies. Primary endpoints included: change in Functional Independence Measure (FIM), FIM efficiency (FIM change/length of stay), rehabilitation failure and discharge FIM above 80.1 We performed t tests and Chi-squared tests to establish differences between cohorts.

Results:

108 patients were accepted for rehabilitation over 36 months, with 24 discharged to an external facility. 36 were declined, with presence of central line (p=0.011), infection/ collection (p=0.012) and prescription of anti-psychotics (p=0.008) significantly higher. Of the 84 patients rehabilitated at Nepean, median FIM at admission (69) and discharge (87) demonstrated significant improvement (p<0.001); mostly in motor domains (FIM: 41 to 63).

We reported elsewhere increased survival for cancer patients with a discharge FIM over 80. Clinical variables associated with achieving a FIM score above 80 included: curative cancer treatment intent (p=0.047), urinary and bowel continence (p=0.027), nil or 1 person transfer assistance (p=0.004), ambulation with up to 1 person assisting (p=0.029) and having a higher FIM at the start of rehabilitation (p<0.001). Poorer outcomes (discharge to an acute team, death in hospital and return to hospital within 30 days) were experienced by those with a discharge FIM <80 (p<0.001), cancer diagnosed more than 1 year ago (p=0.026) and those who had emergency surgery during admission (p=0.005).

Recent anti-cancer treatment, selected nursing measures, biochemistry/haematology data, surgical complications and medications, did not reliably predict FIM change or efficiency prior to Rehabilitation consultation.

Conclusions:

The determinants of effective selection of patients with cancer to inpatient rehabilitation remain heterogenous; encouraging a considered and collaborative approach.

  1. Saotome et. Al 2015. Cancer Rehabilitation: A Barometer for Survival? Supportive Care Cancer, 23:3033-3041.