The Art and Science of Predicting Prognosis in Cancer Rehabilitation

Abstract

Purpose of Review Oncologists are often extremely hesitant to provide life expectancy to patients, their families, and rehabilitation clinicians who need this data to develop a realistic and compassionate plan of care. This review will discuss the art and science of determining prognosis for patients considered for admission to an inpatient rehabilitation facility (IRF). Recent Findings Oncologist overestimate prognosis by as much as fivefold and generally communicate a significantly longer life expectancy to patients and families. Patients with active cancer requiring maximal assistance on admission to an IRF have a nearly 60% chance of acute care discharge. Summary This paper will discuss the art and science of using prognostic determination as a key component of making good decisions with respect in the admission of cancer patients to IRF. Prognosis is best determined prior to admission by rehabilitation professionals based on a comprehensive assessment of the patient’s oncologic history, functional status, and importantly presence or absence of meaningful treatment options. Patients with extremely limited life expectancy should only be admitted on a supportive pathway intent on expeditious discharge home with hospice.