Most cancer patients discharged to skilled nursing facilities do not receive additional cancer treatment or palliative care. Moreover, disappointing improvements in functional status suggest that the rehabilitative intent of their care is not being realized in these post-acute settings, according to a new study.
Investigators analyzed data from more than 6,700 Medicare beneficiaries. Patients had new diagnoses of stage 2 to 4 colorectal, pancreatic, bladder or lung cancer and were referred to NFCs between 2011 and 2013. Researchers examined cancer treatment receipt and palliative care utilization, and calculated changes in activities of daily living (ADL) scores during the SNF stay using minimum data set (MDS) records.
Nearly half (46%) of patients did not receive cancer treatment or palliative care after discharge from an SNF, reported Sarguni Singh, MD, of University of Colorado Hospital. Moreover, only 9% received both cancer treatment and palliative care.
Additionally, MDS-ADL scores did not improve significantly for most patients. But patients whose scores improved the most between their first and last assessment had a decreased risk of death, the authors noted.
Discharge from an SNF is a critical point in the care of a cancer patient and underscores the need for targeted transitions in palliative care (as opposed to palliative care), according to Singh and colleagues. This will help better align discharge decisions with patient care goals, they wrote.
“Given these unmet needs, limited functional gains, and high mortality we found in this study, providing palliative care to this patient population has potential benefits for improving quality of life. [and] controlling symptoms, reducing tedious end-of-life treatments, and improving palliative care utilization,” they concluded.
The authors published a related perspective based on their findings: The patient-centred payment model: a missed opportunity for patient-centred cancer care.
Full results of the current study have been published in JAMDA.