Return to Intended Oncologic Therapy in Patients With Metastatic Non-Small Cell Lung Cancer Discharged to a Skilled...

Hospitalized patients with metastatic non-small cell lung cancer (mNSCLC) and poor performance status are commonly discharged to a skilled nursing facility (SNF) to undergo rehabilitation, with a plan for further systemic therapy as an outpatient. The success rate of this strategy is unknown.

Patients with mNSCLC between 2016 and 2023 discharged to a SNF were retrospectively reviewed, to find the proportion of patients who received further systemic therapy, quantify disease response, and characterize end-of-life care. Multivariable logistic regression was used to identify characteristics associated with receiving further therapy. Kaplan-Meier method was used to estimate overall survival (OS).

Of 427 patients, 131 (30.7%) received further therapy, with 40/54 (74.1%) of those planned for a tyrosine kinase inhibitor, 42/130 (32.3%) of those planned for an immune checkpoint inhibitor, and 49/243 (20.2%) of those planned for chemotherapy (P < .001). On multivariable analysis, the planned therapy type (P < .001) and 6-Clicks score (P < .001) were significantly associated with receiving further therapy. For those 131 patients, 51 (38.9%) died or enrolled in hospice without response assessment, 33 (25.2%) had progression at first assessment, and 48 (35.8%) had stable disease or a partial response. Systemic treatment was given in the last 30 days of life for 44 (33.6%) patients. Median OS was 1.7 months. Of the 410 patients who died, 97 (23.7%) died inpatient and 110 (26.8%) died at a facility without ever returning home.

The number of patients who return to intended oncologic therapy is low, varying by therapy type and performance status. Few have subsequent disease response or stability, with many patients receiving therapy in the last 30 days of life or dying in the hospital.