Description of performance and functional trajectory of acute oncology inpatients at a London tertiary centre.

Purpose

Advances in cancer care and its treatment mean that people living with a cancer diagnosis are living longer but not necessarily living well. It is reported that cancer patients present with multifaceted symptom burden that often impacts on physical performance.

At present exemplar models of cancer rehabilitation exist across the UK along with tumour and symptoms rehabilitation guidance in the form of NCAT Rehabilitation Pathways (National Cancer Action Team, Macmillian Cancer Support 2013). Implementation of these rehabilitation pathways into the inpatient setting can be challenging due to the multifactorial nature and interplay of symptoms cancer patients present with and the resources available.

Our local study primarily aimed to understand the functional trajectory of our acute inpatient population in order to determine how the cancer rehabilitation of the acute population can be optimised in future proposed work.

Key study aims:

  • To describe the acute inpatient oncology population
  • To describe the performance and functional trajectory of the acute inpatient oncology population
  • To feed into a wider project supported by fit for the future looking at “how do we optimise rehabilitation in acute oncology inpatients”
61% of the population had metastatic disease involvement
and all but one patient presented with key symptoms likely to impact on performance or functional status.
The mean change in PS was 0.3 (0-3)
and the mean change in BI= 7.14 (0-50). 
The greatest functional improvements were seen in patients with PS scores 2-4
with a positive relationship shown between a higher performance status score and improvements in BI scores.

Approach

A retrospective review of all inpatients that were new to the cancer physiotherapy team at a London Cancer Tertiary Centre were analysed over a 1month period. Demographic, clinical features, symptom profile, length of stay, performance ability in the form of the performance status (PS) scale, functional ability in the form of the Barthel index (BI) and discharge destination with onward rehabilitation needs were collated on initial assessment and on discharge from hospital.

All patients admitted with a cancer diagnosis were included in the review. Excluded were patients admitted for end of life care management. A descriptive review was conducted and initial assessment and discharge scores in PS and BI were used to determine the functional trajectory of the acute oncology inpatient.

Outcomes

77 patients were reviewed. 61% of the population had metastatic disease involvement and all but one patient presented with key symptoms likely to impact on performance or functional status. The mean change in PS was 0.3 (0-3) and the mean change in BI= 7.14 (0-50).  The greatest functional improvements were seen in patients with PS scores 2-4 with a positive relationship shown between a higher performance status score and improvements in BI scores.

  Greatest improvements in functional outcome were seen in cancer patients with higher PS scores and functional needs. However, all PS subdivisions showed high symptom profiling with an impact on physical performance. Our results highlight the variable and multifaceted symptom burden in an acute oncology inpatient population and the need for cancer rehabilitation to meet the physical and functional needs of cancer patients irrespective of PS.

Cost and savings

Reviewed the effectiveness of service and highlighted areas of development to support cancer rehabilitation discharge pathways. Data was utilised to support the fit for the future project and awarded pilot funding to implement a Cancer Rehabilitation Transition Team (CaRT) to provide intensive rehabilitation improving patient outcomes in the acute setting and increase support with the transition of care into the community.

Implications

Acute oncology inpatients benefit from cancer rehabilitation approach of Dietz model of care (preventative, supportive, restorative and palliative) in order to optimise symptom management and functional performance outcomes irrespective of performance status. Further recommendations of the rehabilitation of acute oncology inpatients is required to optimise resources and the management of functional outcomes for acute cancer patients.

Top three learning points

  1. Prevalence and impact of high symptom burden on functional trajectory and outcomes for cancer patients.
  2. Educating and normalising cancer rehabilitation across the acute and community is key to optimising quality of life of this patient group.
  3. The need for more community service development and equal access to cancer rehabilitation services and guidance on implementing cancer rehabilitation.

Fund acknowledgements

This was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2019

 

Please see the attached Innovations poster below.

For further information about this work please contact Rachael George