Objective assessment of activities of daily living and prognosis in patients with terminal cancer in the palliative care unit: a retrospective cohort study

OBJECTIVES: Rehabilitation in patients with terminal cancer plays an essential role in maintaining quality of life. However, limited consensus exists regarding rehabilitation in the palliative care unit (PCU). This study aimed to support the setting of appropriate goals in the rehabilitation of patients with terminal cancer in a PCU. METHODS: In this retrospective cohort study, 224 patients with terminal cancer admitted to a PCU were analysed. Participants were classified based on total Functional Independence Measure (FIM) score: low (18-53), middle (54-90) and high (91-126). Overall survival (OS) was analysed using Kaplan-Meier curves and Cox proportional hazards regression. Factors associated with discharge to home were identified using logistic regression and receiver operating characteristic curve analysis. RESULTS: Median OS was significantly longer in the high (40 days) and middle (23 days) groups than in the low (15 days) group (p<0.01). Cox proportional hazards regression identified the total FIM score as an independent predictor of OS (HR: 0.58, 95% CI 0.40 to 0.83, p<0.01). Discharge-to-home rates were significantly higher in the high group (62.1%) than in the middle (24.7%) and low (27.5%) groups. Multivariate logistic regression analysis revealed that the total FIM score and number of cohabiting caregivers were independently associated with discharge to home. The cut-off total FIM score for predicting discharge to home was 87.0. CONCLUSIONS: Objective activities of daily living (ADL) assessment using the FIM at PCU admission may help predict OS and the feasibility of home discharge. These findings support the use of standardised ADL measures to facilitate goal setting in rehabilitation.