Predicting Early Mortality in the Inpatient Cancer Rehabilitation Population Using Admission Performance Status Score

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Abstract
Objective: The aim of the study was to determine if a low admission Karnofsky Performance Scale score is indicative of a higher likelihood of death within 3 mos of discharge from inpatient rehabilitation with an active cancer diagnosis. Design: A retrospective, observational design was employed to analyze electronic medical records of 385 patients with a primary or concurrent diagnosis of cancer admitted from a multicenter, acute inpatient rehabilitation hospital system between January 1, 2020, and December 31, 2020. Results: Of the 385 patients, a total of 77 patients (20%) had an observed death within 3 mos. Out of the sample of patients with an observed death within a 15-mo window (n = 157), 49% died within 3 mos of discharge from the IRF. Patients with a Karnofsky Performance Scale score of 40 or less had a significantly higher risk of mortality within 3 mos of discharge (hazard ratio = 1.49, 95% confidence interval = 1.09–2.04, P = 0.013). For those surviving less than 3 mos, average survival was 32 days. Improvements in Karnofsky Performance Scale score during the inpatient stay were linked to better survival outcomes. Conclusions: These findings provide insight into the prognosis of patients with cancer in inpatient rehabilitation, emphasizing the importance of functional assessment in predicting mortality within 3 mos of discharge.

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