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McNair K, Botticello A, Stubblefield MD. Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation. Arch Phys Med Rehabil 2024; 105:947-952. [PMID: 38232794 DOI: 10.1016/j.apmr.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To identify patient factors associated with acute care transfer (ACT) among cancer survivors admitted for inpatient medical rehabilitation. DESIGN An exploratory, observational design was used to analyze retrospective data from electronic medical records. SETTING Data were obtained from 3 separate inpatient rehabilitation hospitals within a private rehabilitation hospital system in the Northeast. PARTICIPANTS Medical records were reviewed and analyzed for a total of 416 patients with a confirmed oncologic diagnosis treated in 1 of the inpatient rehabilitation hospitals between January and December 2020. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of an ACT. Covariates included the adapted Karnofsky Performance Scale (KPS) for inpatient rehabilitation, demographic information, admission date, re-admission status, discharge destination, and cancer-related variables, such as primary cancer diagnosis and presence/location of metastases. RESULTS One in 5 patients (21.2%) were transferred to acute care. Patients with hematologic cancer had a higher risk of ACT compared with those with central nervous system (CNS) cancer. Lower functional status, measured by the adapted KPS, was associated with a higher likelihood of ACT. Patients with an admission KPS score indicating the need for maximum assistance had the highest transfer rate (59.1%). CONCLUSIONS These findings highlight the medical complexity of this population and increased risk of an interrupted rehabilitation stay. Considering patients' performance status, cancer type, and extent of disease may be important when assessing the appropriateness of IRF admission relative to patient quality of life. Earlier and improved understanding of the patient's prognosis will allow the cancer rehabilitation program to meet the patient's unique needs and facilitate an appropriate discharge to the community in an optimal window of time.
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Affiliation(s)
- Keara McNair
- Kessler Institute for Rehabilitation, West Orange, NJ; Rutgers, Department of Rehabilitation and Movement Sciences, School of Health Professions, Newark, NJ.
| | - Amanda Botticello
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael D Stubblefield
- Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
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Bettariga F, Bishop C, Taaffe DR, Galvão DA, Maestroni L, Newton RU. Time to consider the potential role of alternative resistance training methods in cancer management? JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:715-725. [PMID: 37399886 PMCID: PMC10658316 DOI: 10.1016/j.jshs.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
Exercise has emerged as fundamental therapeutic medicine in the management of cancer. Exercise improves health-related outcomes, including quality of life, neuromuscular strength, physical function, and body composition, and it is associated with a lower risk of disease recurrence and increased survival. Moreover, exercise during or post cancer treatments is safe, can ameliorate treatment-related side effects, and may enhance the effectiveness of chemotherapy and radiation therapy. To date, traditional resistance training (RT) is the most used RT modality in exercise oncology. However, alternative training modes, such as eccentric, cluster set, and blood flow restriction are gaining increased attention. These training modalities have been extensively investigated in both athletic and clinical populations (e.g., age-related frailty, cardiovascular disease, type 2 diabetes), showing considerable benefits in terms of neuromuscular strength, hypertrophy, body composition, and physical function. However, these training modes have only been partially or not at all investigated in cancer populations. Thus, this study outlines the benefits of these alternative RT methods in patients with cancer. Where evidence in cancer populations is sparse, we provide a robust rationale for the possible implementation of certain RT methods that have shown positive results in other clinical populations. Finally, we provide clinical insights for research that may guide future RT investigations in patients with cancer and suggest clear practical applications for targeted cancer populations and related benefits.
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Affiliation(s)
- Francesco Bettariga
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, London, NW4 4BT, UK
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Luca Maestroni
- London Sport Institute, School of Science and Technology, Middlesex University, London, NW4 4BT, UK
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4067, Australia.
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3
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Reilly JM, Ruppert LM. Post-acute Care Needs and Benefits of Inpatient Rehabilitation Care for the Oncology Patient. Curr Oncol Rep 2023; 25:155-162. [PMID: 36729252 PMCID: PMC10423402 DOI: 10.1007/s11912-023-01366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This study aims to assess recent literature published on the post-acute care needs of cancer patients, specifically focusing on the acute inpatient rehabilitation setting. RECENT FINDINGS The neurologic cancer population appears to be the most studied oncologic population in acute inpatient rehabilitation studies within the past 5 years. This finding is consistent with prior findings from the past several decades. Recent trends in inpatient cancer rehabilitation note a population with lower admission functional status and shorter lengths of stay compared to prior studies. Despite these findings, the percentage discharged to the community remains high. With new treatments yielding improved survival, cancer patients may live longer and risk accumulating more functional impairments. Physicians involved in their care must understand post-acute care needs and work in a multidisciplinary group to best determine post-acute disposition. This decision remains very individualized and should consider both oncologic and functional needs.
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Affiliation(s)
- Julia M Reilly
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 E 53rd St, New York, NY, USA.
- Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, NY, USA.
| | - Lisa Marie Ruppert
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, 160 E 53rd St, New York, NY, USA
- Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, NY, USA
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Roy I, Huang K, Bhakta A, Marquez E, Spangenberg J, Jayabalan P. Relationship Between Cachexia and the Functional Progress of Patients With Cancer in Inpatient Rehabilitation. Am J Phys Med Rehabil 2023; 102:99-104. [PMID: 35383593 PMCID: PMC9532459 DOI: 10.1097/phm.0000000000002024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Although inpatient rehabilitation can improve functional independence in patients with cancer, the role of cachexia in this population is unknown. Our objectives were to:1) Establish prevalence of cachexia in a cohort of cancer patients receiving inpatient rehabilitation and its association with demographic and oncological history.2) Determine the relationship between the presence of cachexia and functional recovery and whether these patients in inpatient rehabilitation have a distinct prognosis. METHODS This is a retrospective cohort study of 250 patients over 330 admissions to an inpatient rehabilitation facility. Body weight loss threshold and Weight Loss Grading Scale identified patients with and without cachexia. Main outcomes were functional independence measure scores, discharge destination, and 6-mo survival. RESULTS Prevalence of cachexia in inpatient rehabilitation was 59% using consensus body weight loss criteria, and 77% of cancer patients had a Weight Loss Grading Scale score greater than 0. Patients with and without cachexia had similar motor and cognitive gains, although patients with severe cachexia had more limited functional gains ( P < 0.05) and increased odds of acute care return ( P < 0.01). Patients with a Weight Loss Grading Scale score of 4 had decreased survival at 6 mos ( P < 0.05) compared with noncachectic patients. CONCLUSIONS These data suggest that there is a relationship between cachexia and recovery for cancer patients that should be further studied in rehabilitation settings.
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Affiliation(s)
- Ishan Roy
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | - Kevin Huang
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Akash Bhakta
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Marquez
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Prakash Jayabalan
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
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McNair KM, Zeitlin D, Slivka AM, Lequerica AH, Stubblefield MD. Translation of Karnofsky Performance Status (KPS) for use in inpatient cancer rehabilitation. PM R 2023; 15:65-68. [PMID: 34837660 DOI: 10.1002/pmrj.12741] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/18/2021] [Accepted: 11/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Better tools are needed to predict functional decline and oncologic prognosis in inpatient cancer rehabilitation. The Karnofky Performance Status (KPS) is a widely used scale of functional performance in oncology, although the scale differs from current rehabilitation terminology. Use of the KPS in inpatient rehabilitation may support a shared method of communication between cancer rehabilitation providers and the primary oncology teams. OBJECTIVE To establish interrater reliability for translation of the KPS for use in inpatient cancer rehabilitation. DESIGN Retrospective interrater reliability review. SETTING A large inpatient rehabilitation hospital system. PARTICIPANTS Fifty randomized charts were chosen for review from a larger database of all patients admitted to an inpatient cancer rehabilitation program in 2020. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The KPS scale was translated into common inpatient rehabilitation grading consistent with the Continuity and Assessment Record and Evaluation (CARE) Item Set to support its use in this specialty area. Additionally, a list of best practice guidelines and scoring instructions were created to assist raters in determining appropriate levels within the scale. Members of the inpatient cancer rehabilitation team scored all patients within the larger database (n = 424) throughout 2020. A blinded rater completed retrospective chart reviews to score the 50-chart sample. A two-way random effects model was used to calculate an intraclass correlation coefficient (ICC) for the KPS scores at each of three time points (premorbid, admission, and discharge). RESULTS The KPS interpretation for rehabilitation proved to be statistically reliable for the 50-chart sample. The premorbid KPS interrater reliability was acceptable (ICC = 0.67; 95% confidence interval [CI]: 0.40-0.82), admission KPS reliability was good (ICC = 0.88, 95% CI: 0.78-0.93), and discharge reliability was excellent (ICC = 0.96; 95% CI: 0.91-0.98). CONCLUSION The KPS translation at three time points (premorbid, admission, and discharge) during the inpatient rehabilitation continuum has acceptable interrater reliability.
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Affiliation(s)
- Keara M McNair
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
| | - Dana Zeitlin
- Kessler Institute for Rehabilitation, Saddle Brook, New Jersey, USA
| | | | | | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
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Fu JB. The Past, Present, and Future of American Cancer Rehabilitation. Phys Ther Res 2022; 24:187-194. [PMID: 35036251 DOI: 10.1298/ptr.r0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Cancer rehabilitation in the United States has gone from a small obscure rehabilitation subspecialty to an area of intense interest. American cancer rehab's recent growth can be attributed to the ever increasing number of cancer survivors. The future of cancer rehabilitation may be accelerated by the concept of exercise as cancer medicine.
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Affiliation(s)
- Jack B Fu
- University of Texas MD Anderson Cancer Center, USA
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Zhang S, Lin D, Wright ME, Swallow N. Acute inpatient rehabilitation improves function independent of comorbidities in medically complex patients. Arch Rehabil Res Clin Transl 2022; 4:100178. [PMID: 35756989 PMCID: PMC9214302 DOI: 10.1016/j.arrct.2022.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives (1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes. Design Retrospective cohort study. Setting Freestanding inpatient rehabilitation facility. Participants A total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270). Interventions Not applicable. Main Outcome Measures Functional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC). Results Among 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ≥27] vs 67.2% [total FIM gain <27]; P=.024) and FIM efficiency (53.3% [FIM efficiency ≥2.12] vs 67.4% [FIM efficiency <2.12]; P=.025), independent of age, body mass index, sex, race, ethnicity, insurance type, and Charlson Comorbidity Index. The 5 most common reasons for RTAC were cardiac, pulmonary, acute blood loss anemia, infection, and neurologic conditions. Conclusions Among 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.
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Khoo T, FitzGerald A. Exploring the value of neuro-oncological rehabilitation within a neurorehabilitation setting. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge. Cancers (Basel) 2021; 13:cancers13246187. [PMID: 34944808 PMCID: PMC8699253 DOI: 10.3390/cancers13246187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary After undergoing an allogeneic haematopoietic stem cell transplantation (alloHCT), patients need intensive physiological and psychological rehabilitation. This should start immediately after discharge from the transplant ward as in- or outpatient rehabilitation. The rehabilitation centres should be qualified and experienced because this patient group exhibits problems that differ from those of patients who have undergone oncological therapies or autologous HCT. An experienced multidisciplinary team in close consultation with the primary transplantation centre should perform the rehabilitation therapy. This review will show the special challenges of these patients according to different timepoints after HCT. Because there is so little data available, personal experience and general guidelines on patient care after alloHCT are presented. Abstract The general population is getting older and suffer more haematological malignancies despite being physically fit. These malignancies are mainly only curable via an alloHCT, and they are now carried out more frequently. Patients benefit from intensive rehabilitation earlier and may need it repeatedly in cases of severe side effects (e.g., graft-versus-host disease). They can suffer many problems that other cancer patients do not experience, such as severe infections, continued immunosuppression, nutritional restrictions, acute or chronic GvHD, or organ impairments (e.g., lung, eyes). They may also encounter various associated psychological problems, e.g., feeling like a chimera. Rehabilitation centres willing to care for patients after alloHCT should have an experienced multidisciplinary team and should work in close co-operation with the primary transplant centre.
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10
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Zhang S. Chemotherapy-induced peripheral neuropathy and rehabilitation: A review. Semin Oncol 2021; 48:193-207. [PMID: 34607709 DOI: 10.1053/j.seminoncol.2021.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication after chemotherapy that can damage the sensory, motor, autonomic, or cranial nerves in approximately 30%-60% of patients with cancer. CIPN can lead to detrimental dose modifications and/or premature chemotherapy discontinuation due to patient intolerance. The long-term impact of CIPN is particularly challenging and can have a profound impact on the quality of life (QoL) and survivorship. However, this condition is often underdiagnosed. No agents have been established to prevent CIPN. Pre-chemotherapy testing is recommended for high-risk patients. Duloxetine is considered a first-line treatment, whereas gabapentin, pregabalin, tricyclic antidepressants, and topical compounding creams may be used for neuropathic pain control. Home-based, low-to-moderate walking, and resistance exercise during chemotherapy can reduce the severity and prevalence of CIPN symptoms, especially in older patients. Pre-habilitation and rehabilitation should be recommended for all patients receiving cytotoxic chemotherapies. The purpose of this article is to review common chemotherapeutic drugs causing CIPN, risk factors, diagnosis and treatment of CIPN, and evidence of the benefits of rehabilitation.
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Affiliation(s)
- Shangming Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey medical Center, Hershey, PA.
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11
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Mack A, Arrigo M, Fink T, Garrity K, Cox D, Kwasnowski L, Wong J. Fatigue and functional outcomes in cancer rehabilitation. Support Care Cancer 2021; 29:8069-8076. [PMID: 34231039 DOI: 10.1007/s00520-021-06405-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is one of the most common symptoms experienced by oncology patients, though its impact on functional outcomes during inpatient rehabilitation is relatively unknown. The purpose of this study is to determine whether CRF severity on admission is related to functional gains following standard rehabilitation care in an inpatient oncology rehabilitation population. METHODS A retrospective cohort study was conducted within an inpatient oncology unit at a long-term acute care hospital. Seventy-six patients admitted to the hospital between April and December 2015 with an oncology diagnosis, planned discharge, and completed standardized assessments of CRF and functional ability were included in this study. Patients received standard interdisciplinary rehabilitation services including physical and occupational therapy. CRF was assessed on admission using the Brief Fatigue Inventory, and functional abilities were assessed on admission and discharge using the basic mobility and daily activity domains of the Activity Measure for Post-Acute Care inpatient short forms (AM-PAC). RESULTS Ninety-seven percent of patients reported CRF, and 57% reported severe CRF upon admission. Patients demonstrated on average a 30% and 14% reduction in functional impairment in basic mobility and daily activity respectively during their admission. There was no significant correlation found between CRF on admission and change in functional impairment. CONCLUSION This study contributes to existing literature in that it found patients who received inpatient rehabilitation services demonstrate significant improvement in their functional status despite reporting CRF upon admission to a long-term acute care hospital oncology unit.
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Affiliation(s)
- Amanda Mack
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA. .,MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA.
| | - Monica Arrigo
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA.,MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
| | - Twyla Fink
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA.,Salem State University, 352 Lafayette St, Salem, MA, 01970, USA
| | - Karla Garrity
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA
| | - David Cox
- MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
| | - Lauren Kwasnowski
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA.,MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
| | - John Wong
- MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
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Nishioka S, Aragane H, Suzuki N, Yoshimura Y, Fujiwara D, Mori T, Kanehisa Y, Iida Y, Higashi K, Yoshimura-Yokoi Y, Sato C, Toyota M, Tanaka M, Ishii Y, Kosaka S, Kumagae N, Fujimoto A, Omura K, Yoshida S, Wakabayashi H, Momosaki R. Clinical practice guidelines for rehabilitation nutrition in cerebrovascular disease, hip fracture, cancer, and acute illness: 2020 update. Clin Nutr ESPEN 2021; 43:90-103. [DOI: 10.1016/j.clnesp.2021.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 12/21/2022]
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13
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Chowdhury N, Scott C, O'Dell MW. Recovery in glioblastoma multiforme during inpatient rehabilitation is equivalent in first versus repeat resection: A 10-year retrospective analysis. PM R 2021; 14:40-45. [PMID: 33583134 DOI: 10.1002/pmrj.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inpatient rehabilitation improves function in people with brain tumors, including glioblastoma multiforme (GBM) but there are limited data on the impact of multiple resections on outcomes. We hypothesize that outcomes will be more favorable for those patients with a single resection when compared to those with more than one resection. OBJECTIVE To examine functional outcomes in inpatient rehabilitation for people with GBM who underwent one or more resections prior to admission. DESIGN Retrospective analysis. SETTING Inpatient rehabilitation unit within a large, urban, academic medical center. PARTICIPANTS Patients who were admitted to our institution for the treatment of initial GBM or GBM recurrence necessitating surgical resection or repeat resection. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Total FIM Change, Total Functional Independence Measure (FIM) Efficiency, Motor and Cognitive FIM efficiency, and proportion discharged home. RESULTS From 2006 to 2016, 94 persons with GBM were admitted. Eight were readmissions classified as "repeat" and another seven transferred to the medical floor and excluded. Of the 79 patients included, 56 were first and 23 second resections, with a group mean age of 62.7 + 12.2 years and were 51% male. On analysis of covariance, change in FIM score from admission to discharge was insignificant between groups, adjusted for age and acute care length of stay (17.1 vs. 17.4, F[1, 75] = 0.027, P = .871). Likewise, the proportion of home discharge was not significant between groups (chi-square, 75.0% vs. 78.3%, P = .758). CONCLUSIONS Patients who have undergone second resections for GBM are reasonable candidates for admission to the inpatient rehabilitation units despite carrying a poor prognosis and having multiple exposures to surgical morbidity. Factors to take into account are that candidates considered for a second resection may be relatively younger or healthier and therefore may perform better from a functional standpoint. In addition, postoperative steroid administration may play a role in the similarities the authors noted. A larger, multicenter study should validate our findings (limited by sample size and a single location) and identify factors predicting a successful outcome.
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Affiliation(s)
- Nasim Chowdhury
- Department of Rehabilitation Medicine, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Charles Scott
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
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Jain P, Balkrishanan K, Nayak S, Gupta N, Shah S. Onco-Anaesthesiology and palliative medicine: Opportunities and challenges. Indian J Anaesth 2021; 65:29-34. [PMID: 33767500 PMCID: PMC7980239 DOI: 10.4103/ija.ija_1556_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022] Open
Abstract
Global cancer burden is on the rise and many more patients present for surgery or other oncological diagnostic or therapeutic interventions requiring anaesthesia. Oncology therapy is unique as it requires a multidisciplinary team of surgical, medical and radiation oncologists apart from palliative medicine (PM) specialists, and anaesthesiologists. Anaesthetic management can affect the outcome of oncology treatment both by ensuring early return to oncology treatment and some anaesthetic techniques being innately associated with recurrence. Hence, the time has come for a separate super-speciality of onco-anaesthesiology to cater to the complex unmet needs of cancer patients. PM is the fourth dimension of oncology care and so mandatory education and training should be included in the undergraduate curriculum.
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Affiliation(s)
- Parmanand Jain
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kalpana Balkrishanan
- Department of Anesthesia, Pain and Palliative care, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Sukdev Nayak
- Department of Anaesthesiology, AIIMS, Bhubaneswar, Orissa, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesiology and Palliative Medicine, AIIMS, New Delhi, India
| | - Shagun Shah
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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15
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Bilek AJ, Borodin O, Carmi L, Yakim A, Shtern M, Lerman Y. Older patients with active cancer have favorable inpatient rehabilitation outcomes. J Geriatr Oncol 2021; 12:799-807. [PMID: 33358109 DOI: 10.1016/j.jgo.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the characteristics and rehabilitation outcomes of older patients with active cancer (OPAC) undergoing post-acute inpatient rehabilitation (IR), and to evaluate which clinical factors are associated with poor rehabilitation outcomes. MATERIALS AND METHODS This is a retrospective study of patients aged ≥65 with active cancer undergoing IR following acute hospitalization at our tertiary hospital centre (N = 330). We collected data on patient, malignancy, and hospitalization characteristics, and IR outcomes including function, mobility, discharge destination, and mortality. Multivariate stepwise logistic regression was used to identify independent associations with the composite outcome of death within three months or discharge to long-term care (LTC). RESULTS Patient mean age was 80.1 ± 7.2 years. The most common malignancies were colon (30.9%) and hematologic (16.1%). Most patients were hospitalized urgently (64.8%) and underwent surgery (72.4%). From IR admission to discharge, patients ambulating independently increased from 14.0% to 52.0%. Discharge destination was to the community (80.4%), to LTC (7.6%), and transfer to an acute ward (7.2%), while 4.8% died during IR. One-year survival was 62.1%. The composite outcome was met by 24.8% of patients with multivariate logistic regression revealing independent associations (p < 0.05) with high baseline dependency, metastatic disease, low mobility score on IR admission, complications during acute care, and ≥ 75th percentile values for lactate dehydrogenase and alkaline phosphatase. CONCLUSION OPAC have favorable IR outcomes including high rate of community discharge, function and mobility gains, and lower mortality rates when compared with previously studied cancer rehabilitation populations. We identified several clinical markers associated with the composite outcome, which can guide post-acute discharge planning in patients with an unclear prognosis.
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Affiliation(s)
- Aaron Jason Bilek
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel.
| | - Oksana Borodin
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel; Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
| | - Liad Carmi
- Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
| | - Ariel Yakim
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel
| | - Michael Shtern
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel
| | - Yaffa Lerman
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel; Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
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Moving beyond symptom management towards cancer rehabilitation for older adults: Answering the 5W's. J Geriatr Oncol 2018; 9:543-549. [DOI: 10.1016/j.jgo.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
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Fu JB, Morishita S, Yadav R. Changing Paradigms in the Rehabilitation of Inpatients with Brain Tumors. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:115-120. [PMID: 29868247 PMCID: PMC5983897 DOI: 10.1007/s40141-018-0182-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neurologic tumors account for over 50% of American acute inpatient rehabilitation facility cancer admissions. WHO Grade IV astrocytoma (also known as glioblastoma multiforme, high grade glioma or GBM) is the most common primary brain tumor in adults and is invariably fatal. The majority of primary brain tumor patients experience neurologic deficits. However, under-referral from oncology to rehabilitation has been reported. This brief narrative review article covers functional, medical and regulatory considerations when rehabilitating brain tumor inpatients.
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Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Rajesh Yadav
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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