Closeup of man on crutches being helped to walk by a physical therapist

Most patients discharged to skilled nursing facilities with cancer do not receive further cancer treatment or hospice care. In addition, underwhelming improvements in functional status suggest that the rehabilitative intent of their care is not being realized in these post-acute settings, a new study finds.

Sarguni Singh, M.D.

Investigators analyzed data from more than 6,700 Medicare recipients. Patients had new diagnoses of stage 2 to 4 colorectal, pancreatic, bladder or lung cancer and were discharged to SNFs between 2011 and 2013. The researchers looked at receipt of cancer treatment and hospice use, and calculated changes in activities of daily living (ADL) scores during SNF stay using Minimum Data Set (MDS) records.

Nearly half (46%) of the patients did not receive either cancer treatment or hospice after discharge to an SNF, reported Sarguni Singh, M.D., of the University of Colorado Hospital. What’s more, only 9% received both cancer treatment and hospice care. 

In addition, MDS-ADL scores did not improve significantly for most patients. But patients whose scores improved the most between their first and last assessments had a decreased risk of death, the authors noted. 

Discharge to an SNF is a critical point in a cancer patient’s care and underscores the need for targeted palliative care transitions (as distinguished from hospice care), according to Singh and colleagues. This will help better align discharge decisions with patients’ care goals, they wrote.

“Given these unmet needs and the limited functional gains and high mortality we found in this study, providing palliative care for this patient population has potential benefit to improve quality of life [and] symptom control, decrease burdensome end-of-life treatment and improve hospice utilization,” they concluded.

The authors have published a related perspective based on their findings: The patient-driven payment model: A missed opportunity for patient-centered cancer care.

Full findings of the current study were published in JAMDA.