Cancer patients admitted to nursing homes: What do we know?

Tens of thousands of cancer patients, representing 10% to 15% of nursing home residents, are admitted to nursing facilities every year. Patients with a cancer diagnosis have a greater than 50% probability of death during the first year. Due to this statistic, or expectation, most studies that identify cancer patients in nursing homes have focused on end-of-life care, the evaluation of the quality of pain management, and predictors of nursing home death. Studies of cancer databases have examined place of death as one component of the cost of cancer care and quality of end-of-life care. This literature provides little descriptive or evaluative data about the over 40% of cancer patients admitted to nursing facilities who do not die there. Clinical experience is that this is a prognostically diverse group. This review will summarize what is known about cancer patients in nursing homes and anticipate important clinical issues in addition to end-of-life care for physicians, medical directors and nurses in long-term care. These include estimating cancer survival, anticipating chemotherapy-related drug toxicity and managing transitions of care.