Background: After discharge from an acute care hospitalization, cancer patients may choose to pursue rehabilitative care in a skilled nursing facility (SNF). Our objective was to examine receipt of anti-cancer therapy, death, readmission, and hospice use of cancer patients who discharge to a SNF compared to those who discharge home or home with home health services in the 6 months following an acute care hospitalization.

Methods: We conducted a population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database of patients with stage II – IV colorectal, pancreatic, urinary bladder, or lung cancer who had an acute care hospitalization between 2010-2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates.

Results: Of patients discharging to SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiation, and targeted chemotherapy, respectively, whereas the rates were 54%, 28%, and 6% for patients discharging to home. Fifty-six percent of patients discharging to SNF died within 6 months of their hospitalization compared to 36% discharging to home. Thirty-day readmission rates were 29% and 28% for patients discharging to SNF and home, respectively. Twelve percent of patients in hospice received less than 3 days of hospice care prior to their death regardless of their discharge location.

Conclusions: Patients with cancer who discharge to a SNF are significantly less likely to go on and receive oncologic treatment of any kind and have higher mortality compared to patients who discharge home after an acute care hospitalization. If the intent of SNF care is to transition home, become independent, and/or continue to receive oncologic treatment then we have shown that the majority of patients in this study who discharge to a SNF do not realize this goal. Next steps include better understanding patients’ goals of care when discharging to a SNF and developing and implementing targeted interventions that improve Palliative Care delivery models to patients in the SNF setting

IMAGE 1: Table 1. Patient and Index Hospitalization Characteristics by Discharge Setting

IMAGE 2: Table 1. Patient and Index Hospitalization Characteristics by Discharge Setting