Return to intended oncologic therapy in patients with metastatic non-small cell lung cancer discharged to a skilled nursing facility.

Abstract

e23062 Background: Hospitalized patients with metastatic non-small cell lung cancer (mNSCLC) with poor performance status are commonly discharged to a skilled nursing facility (SNF) to undergo rehabilitation, with a plan for further systemic therapy as an outpatient. The success rate of this strategy is unknown. Methods: This retrospective study was performed by searching the institutional electronic medical record for admissions between 2016-2023 ending in discharge to a SNF, including a C34 ICD-10 code. These records were reviewed to find patients with mNSCLC. The primary outcome was the proportion of patients who received further systemic therapy following SNF rehabilitation. Secondary outcomes included disease response and quality indicators. Multivariable logistic regression with univariate variable selection was used to identify characteristics associated with receiving further therapy. Charlson Comorbidity index, 6-Clicks score at discharge, and planned treatment type were included a priori in the multivariable model. Results: A total of 427 patients met inclusion criteria, of whom 229 (53.6%) returned for an oncology appointment. In total, 131 (30.7%) received further therapy, with 40/54 (74.1%) of those planned for a tyrosine kinase inhibitor, 42/130 (32.3%) of those planned for immunotherapy alone, and 49/243 (20.2%) of those planned for chemotherapy (p < 0.001). On multivariable analysis, the patient’s planned therapy (p < 0.001) and 6-Clicks score (p < 0.001) were significantly associated with receiving further therapy (Table). Of the 131 who received further therapy, 51 (38.9%) died or enrolled in hospice without response assessment, 33 (25.2%) had progression at first assessment, and 47 (35.9%) had stable disease or a partial response. Systemic treatment was given in the last 30 days of life for 44 (33.6%) patients. Median overall survival was 1.7 months. Of the 410 patients who died, 97 (23.7%) died inpatient and 110 (26.8%) died at a facility without ever returning home. Hospice enrollment was confirmed in 217 (50.8%), with a median duration of 10.0 days. Conclusions: The number of patients who successfully rehabilitate at a SNF to return to intended oncologic therapy is low, but varies by therapy type and functional status at hospital discharge. Only a limited proportion have subsequent disease response or stability, with many patients receiving therapy in the last 30 days of life or dying in the hospital. Covariates in Multivariable Model Odds Ratio (95%CI) p-value Charlson Comorbidity Index (per 1 unit increase) 0.87 (0.74-1.01) 0.07 Hospital Length of Stay (per day) 0.98 (0.94-1.02) 0.26 6-Click Score (per 1 unit increase) 1.11 (1.05-1.19) <0.001 Treatment Naïve 0.72 (0.44-1.17) 0.193 ICU Stay 0.59 (0.31-1.07) 0.09 Planned Outpatient Therapy Chemotherapy Ref Immunotherapy 1.83 (1.11-3.04) 0.02 Tyrosine Kinase Inhibitor 13.1 (6.42-28.4) <0.001