Cancer treatment, polypharmacy, cognition and disability status are all factors that can influence an oncologist’s choice to refer a patient for rehabilitation, a new study finds.
Referral was not independently associated with change in functional disability, health-related quality of life or survival, according to the study published Nov. 2 in Journal of the American Geriatrics Society.
The authors would like to see future studies evaluate patients’ utilization of rehabilitation services after they receive a referral. The studies should also determine whether the dose or timing of rehabilitation services affects clinical outcomes.
Older adults with advanced cancer experience functional disability that necessitates rehabilitation services, but there have been inconsistencies in referral. The authors wanted to identify what predicted referrals to rehabilitation centers that were led by a geriatric assessment, an exam that’s necessary to see if a referral is needed. Investigators also wanted to understand the associations between referral and change in function, health-related quality of life and survival among older adults with advanced cancer. The team conducted a secondary analysis of a clinical trial that had already been conducted.
Of the 265 participants, all were older adults with advanced cancer who had at least one physical or functional impairment. Participants were 77 years old on average. The team assessed oncologist-initiated discussions about or referral to rehabilitation services after the geriatric assessment. Researchers also evaluated the decline in activities of daily living (ADL), instrumental ADL (IADL), and health-related quality of life within 3 months, and overall survival at 1 year.
Of the 93% of older adults with advanced cancer who had a geriatric assessment and showed physical and/or functional deficits, 25% received a referral for rehabilitation.
Impaired cognition, disability score and receiving monoclonal antibodies were linked to higher odds for being referred, while polypharmacy was associated with lower odds for being referred. Those referred for rehabilitation were less likely to decline in ADL and IADL, but more likely to have declines in health-related quality of life and more likely to have worse survival.
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