Association of Cancer Status, Functional Outcomes, and Mortality in Australian Geriatric Rehabilitation Patients, RESORT

Abstract

Objectives: Increased cancer survival has led to a growing population of geriatric patients with cancer. The post-acute rehabilitation outcomes of these patients are poorly understood. This study aimed to investigate whether cancer status is associated with functional outcomes, new institutionalization, and mortality in Australian geriatric rehabilitation patients.

Design: Observational longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort.

Setting and participants: Geriatric rehabilitation patients in a tertiary hospital in Australia.

Methods: Patients were allocated to "no," "past," and "active" cancer status groups. Function was measured at geriatric rehabilitation admission and discharge using Katz Activities of Daily Living (ADL) and Lawton-Brody Instrumental ADL (IADL) scores. Logistic regression and Cox regression were performed to investigate the association between functional change with new institutionalization and 1-year mortality, respectively.

Results: Of 1890 patients, 77.7% had "no," 13.3% had "past," and 9.0% had "active" cancer. ADL and IADL scores improved in all groups, with no significant difference between groups in functional outcomes or new institutionalization. Compared with "no" cancer (2.9%), a significantly higher proportion of "active" (8.2%) and "past" (6.0%) cancer patients died during the hospital admission, P < .001. Active cancer was associated with higher 3- and 12-month mortality (20% and 40.6%). ADL and IADL improvement were significantly associated with reduced risk of 12-month mortality in "no" and "active" groups, and lower incidence of institutionalization in all groups.

Conclusions and implications: Although inpatient mortality is higher in active cancer patients, older adults with active cancer who survive until inpatient geriatric rehabilitation discharge achieve similar functional gains and rates of discharge to the community. Functional improvement is of prognostic value in active cancer patients.

Keywords: Geriatric; aging; cancer; function; mortality; rehabilitation.