Evaluation and pharmacologic management of symptoms in cancer patients undergoing acute rehabilitation in a comprehensive cancer center

Abstract

Objectives: To identify cancer patients' symptoms at admission and on discharge from an acute rehabilitation unit, to document the discharge medications used for symptom management, and to assess how symptoms affect lengths of stay (LOS).

Design: Retrospective chart review.

Setting: Acute inpatient rehabilitation unit within a tertiary cancer center.

Participants: Ninety-six patients (49 men, 47 women) were admitted to an acute inpatient rehabilitation unit. The median age was 64 years (range, 26-87y).

Interventions: Not applicable.

Main outcome measure: Edmonton Symptom Assessment Scale (ESAS) scores at admission and on discharge.

Results: The most intense symptom (mean ESAS visual analog scale score +/- standard deviation) on admission was poor appetite (3.7+/-3.3), followed by fatigue (3.4+/-2.6). Similar results were found for the 63 patients with ESAS scores available at both time points. On discharge, poor appetite (2.2+/-2.4) was still the most intense symptom reported, again followed by fatigue (2.2+/-2.1). There were significant improvements in anxiety (P=.001), constipation (P=.001), fatigue (P=.002), pain (P=.003), appetite (P=.004), sense of well-being (P=.01), and insomnia (P=.04). Seventy percent (65/93) of patients received discharge prescriptions for symptom control, with analgesics being the most frequently prescribed. The poor appetite and depression admission scores correlated positively with hospital LOS (P<.001, P=.05, respectively).

Conclusions: Assessment of symptoms revealed significant symptom burdens in cancer patients undergoing rehabilitation. Pharmacologic interventions for management of symptoms were frequently needed.