Rehab or radiation?: That is the question.

52 Background: Hospitalized patients (pts) with an indication for radiation therapy (RT) may also require discharge to a subacute rehabilitation facility (SAR). However, certain insurance plans might not permit RT while admitted to SAR, requiring the completion of RT inpatient or the initiation of RT after SAR discharge. We hypothesized that pts who can receive RT while admitted to SAR have lower length of stay (LOS), thus preserving hospital resources and timely RT delivery. Methods: We examined a cohort of hospitalized pts at a single urban tertiary cancer center for whom radiation oncology was consulted and were then discharged to SAR between January 2019 to February 2024. We identified pts who received RT during the hospitalization or within 30 days of hospital discharge. We then examined pts who received RT prior to discharge to SAR (IN-PT RT), pts who received RT while admitted to SAR (SAR-RT), and pts who received RT after discharge from SAR but within 30 days of discharge from the hospital (PostSAR-RT). We examined mean age, race/ethnicity, baseline Karnofsky Performance Status (KPS), insurance, radiation technique, and site treated as predictors of outcome. We also examined various time intervals related to hospital admission, discharge, and RT consult and start. Chi-square testing was used for non-continuous variables and with Mann-Whitney/Kruskal-Wallis testing for continuous variables. Results: Overall, of the initial cohort (n=337), 52.2% (n=176) were IN-PT RT, 6.5% (n=22) were SAR-RT, and 3.8% (n=13) PostSAR-RT. Demographics and RT course data across groups are listed in Table 1. IN-PT RT had a significantly higher proportion of privately insured pts than SAR-RT (p=0.039). In all, pts were treated to 263 sites with predominantly palliative intent. 33% were non-spine bone lesions (n=86), 27.5% were spine lesions (n=72), and 25% were brain lesions (n=66). 28.4% (n=50) of IN-PT RT received ultra-hypofractionated SBRT. IN-PT RT had higher LOS of 24 days than SAR-RT (10 days, p <0.001) and PostSAR-RT (12 days, p < 0.001) but no difference in time from admission to inpatient RT consultation (6 days; 5 days; 6 days (p=0.572)). Conclusions: Pts who receive RT inpatient prior to discharge to SAR have double the LOS than those receiving RT at SAR, despite similar times from admission to inpatient consultation. IN-PT RT (N=176) >SAR-RT (N=22) PostSAR-RT (N=13) Count (%) Median (Range) Count (%) Median (Range) Count (%) Median (Range) P Value Sex Male Female 86 (49)90 (51) 11 (50)11 (50) 7 (54)6 (46) 0.94 Age (Years) 68 (19-89) 76 (41-90) 68 (50-87) Race White Black Asian Other/Unknown 125 (71)32 (18)9 (5)10 (6) 19 (86)2 (18)0 (0)1 (5) 10 (77) 1 (8)1 (8)1 (8) 0.71 Insurance Medicare/Medicaid Private Self Pay/None Listed 99 (56)57 (32)20 (11) 16 (73)1 (5)5 (23) 9 (69)4 (31)0 (0) 0.039 KPS at Consultation 60 (50-90) 70 (40-80) 50 (50-90) 0.109 RT Intent Definitive Palliative 5 (3)171 (97) 6 (27)16 (73) 5 (15)11 (85) 0.001 Days from Consult to RT start 4 (0-46) 11 (1-21) 21 (11-26) <0.001