New JOP Study on Use of Subacute Rehabilitation Provides Insights When Establishing Goals of Care for Immunotherapy Treatments

September 10, 2019

A new study in the Journal of Oncology Practice (JOP) comparing the use of subacute rehabilitation (SAR) instead of hospice referral since the availably of immunotherapy finds a growing number of people with cancer are being discharged to SAR, but approximately two-thirds do not receive further cancer therapy at any point. This research provides important insights for goals of care.

With the dawn of immunotherapy as a mainstream treatment option for cancer, there has been an observed decline in referrals from inpatient oncology to hospice, and an increase in referrals to SAR. A hypothesis for this shift has been that patients are referred to SAR with the aim of getting strong enough to handle immunotherapy and other promising drugs.

This study was comprised of chart reviews from 2009-2017 from a single hospital system using patient-discharge data from the inpatient oncology units to SAR facilities.

Within this eight-year span, 358 patients were referred to SAR 413 times with the following results:

  • 174 patients (49%) returned to the oncology clinic prior to re-admission or death
  • 117 (33%) received further cancer-directed treatment (chemotherapy, radiation, or immunotherapy)

Among those discharged, 28% were readmitted within 30 days and 74 patients (21%) were deceased within 30 days Only 31% of the patients were referred to hospice.

While an increase of referrals to SAR coincided with the period of time that immunotherapy became more widely available, this occurred despite a simultaneous increase in hospice referrals during the same time frame.

Study authors believe that this may reflect growing provider awareness of hospice and palliative care services at the institution and in the field at large. The results from this study also demonstrated important trends in palliative and supportive care. Patients with palliative care involvement resulted in more frequent do not resuscitate (DNR) code status, documented goals of care (GOC) discussions, and electronic advance directives.

Despite study limitations, this research has important implications for goals of care. Further, it identified several factors that were associated with improved survival and greater likelihood of cancer therapy after SAR including younger patients with leukemia, lymphoma, or localized solid disease.

Read the full study in JOP.

Read ASCO’s resources on Immunotherapy and Supportive and Palliative Care.