Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study

The association between sarcopenia, defined by a simplified screening tool, and long-term outcomes

BACKGROUND

Sarcopenia and frailty are frequently observed in older adult patients and linked to unfavorable postoperative outcomes. Identifying low muscle mass and function is primary for diagnosing sarcopenia. The simpler screening, which excludes muscle mass measurement, exhibited strong predictive capabilities in identifying sarcopenia. This research explored the association between sarcopenia, as defined by the C3 formula, and long-term outcomes in older adult cancer patients who underwent surgery.

METHODS

Surgical cancer patients aged 60 and older were enrolled. Sarcopenia was identified using the C3 formula, assessing muscle strength through handgrip strength, physical performance via a 6-m walk test, and nutrition status via the Mini Nutritional Assessment-Short Form. Long-term outcomes were evaluated with the Barthel Index for activities of daily living (B-ADL) at 3 months, as well as 1-year mortality rates.

RESULTS

The study enrolled 251 patients, with 130 classified as sarcopenic according to the C3 formula. Compared with nonsarcopenic patients, patients with sarcopenia exhibited a higher frequency of moderate to severe disability (B-ADL ≤70) 3 months postdischarge (19.5% vs 5.2%; P = 0.001) and elevated 1-year mortality rates (29.5% vs 14.9%; P = 0.006). No significant differences were observed in infection rates, hospital stay duration, or in-hospital mortality. Distant organ metastasis (HR = 3.99; 95% CI = 2.25-7.07) and sarcopenia defined by the C3 formula (HR = 1.78; 95% CI = 1.01-3.15) were identified as independent risk factors for 1-year mortality.

CONCLUSION

The simplified sarcopenia screening tool was associated with increased rates of moderate to severe disability 3 months postdischarge and higher 1-year mortality rates compared with nonsarcopenic patients.

Decreased bed mobility function is associated with post-discharge mortality for cancer patients in inpatient rehabilitation

OBJECTIVE

The establishment of rehabilitation goals for hospitalized cancer patients depends on accurate medical prognosis and matching goals to clinical timelines. Current tools for estimating prognosis are limited. We hypothesized that bed mobility is a predictor of mortality in cancer patients admitted to inpatient rehabilitation.

DESIGN

In a retrospective cohort of 187 subjects with non-neurologic cancer admitted to inpatient rehabilitation, Functional Independence Measure (FIM) scores and 6-month mortality were analyzed.

RESULTS

In the cohort, survival rate was 71% at 6 months. In univariate analysis, discharge bed mobility score (OR = 0.75, 95%CI = 0.61 to 0.90, p = 0.003), bed mobility FIM gain (OR = 0.66, 95%CI = 0.51 to 0.85, p = 0.002), and bed mobility FIM efficiency (OR = 0.011, 95%CI = 0.00032 to 0.21, p = 0.006) were inversely associated with 6-month mortality after discharge from IRF. In multivariate analysis with additional motor FIM items, only bed mobility (OR = 0.73, 95%CI = 0.54 to 0.97, p = 0.029) and grooming (OR = 0.79, 95% CI = 0.63 to 0.99, p = 0.041) were independently associated with mortality.

CONCLUSIONS

Lower discharge and lower change in bed mobility FIM scores are associated with mortality in cancer patients in inpatient rehabilitation. Bed mobility could serve as a clinical tool for estimating medical prognosis in hospitalized cancer patients and should be validated in prospective studies.

Post-acute Care Needs and Benefits of Inpatient Rehabilitation Care for the Oncology Patient

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.