Changes in Patterns of Referral for Inpatient Rehabilitation Cancer Patients Due to COVID-19: A Retrospective Study.

ABSTRACT: There is a paucity of literature on the effect of COVID-19 on hospital processes. We hypothesized that COVID-19 was associated with decreased cancer physiatry referrals in 2020. This is a retrospective cohort study of consecutive patients from April to July 2019 and 2020 admitted at an academic quaternary cancer center. The main outcomes were number of hospital admissions, rate, and characteristics of inpatient rehabilitation admissions and change in percentage of physiatry referrals as the primary endpoint. Results showed that in 2019, there were 387 referrals from 10,274 inpatient admissions (3.8%; 95% confidence interval, 2.4-4.2), compared with 337 referrals from 7051 admissions in 2020 (4.8%; 95% confidence interval, 4.3-5.3, P = 0.001). Hematology services referred more patients than neurosurgery in 2020 (20.4% vs. 31.4%; 48.2% vs. 26.5%, P = 0.01). Discharge disposition reflected an increased frequency of return to acute care service in 2020 (10.2% vs. 21.8%, P = 0.03). In conclusion, there was an increase in the rate of physiatry referrals despite a decrease in hospital admissions. There was an increase in referrals by hematology, likely due to emphasis on safe discharge and the populations hospitalized.

Pulmonary rehabilitation improves functional status in oncology patients.

OBJECTIVE: To determine if participation in a pulmonary rehabilitation (PR) program improved the functional and physiologic status of oncology patients with chronic symptoms of shortness of breath, fatigue, and/or exercise intolerance. DESIGN: Retrospective chart review. SETTING: Comprehensive cancer center. PATIENTS: Oncology patients (N=30) (either a solid or a hematologic malignancy) with chronic dyspnea, exercise intolerance, and/or decreased functional status who had participated in an outpatient PR program. INTERVENTIONS: The PR program used an individualized, progressive aerobic exercise program (2-3 sessions/wk for 8-12 weeks) that consisted of treadmill walking, riding on a bicycle ergometer and exercising on a sliding board. This program also included a didactic educational and psychosocial component. MAIN OUTCOME MEASURES: Functional status and exercise tolerance was assessed by the 6-minute walk test (6MWT) conducted at the beginning and end of the program. Self reports of perceived exertion and dyspnea were collected during and after these tests. Physiologic status was assessed by calculating 6-minute walk work (body mass x 6-minute walk distance). RESULTS: Participation in the outpatient PR program significantly increased the 6-minute walk distance (21%, P<.05) and 6-minute walk work (17%, P<.05). Dyspnea and perceived exertion scores were similar at the pre- and postrehabilitation 6MWT despite the greater physiologic demand of the post-rehabilitation 6-minute walk. No adverse events occurred during the study. CONCLUSIONS: The current study, although limited in size, suggests that participation in a comprehensive outpatient PR program is safe and of benefit in a heterogeneous population of oncology patients with pulmonary symptoms.