SUPC-04 OUTPATIENT REHABILITATION AFTER BRAIN-METASTASIS TREATMENT: A CLAIMS-BASED ANALYSIS OF UTILIZATION, ACUTE CARE USE, AND INSURANCE ENROLLMENT
Thomas Otten, Bennett TaylorAbstract
Background
Brain-metastases represent a morbid complication of cancer, often resulting in significant impairment beyond initial treatment. Current guidelines recommend multidisciplinary care, including rehabilitation. While inpatient rehabilitation has shown benefit, early outpatient rehabilitation remains poorly characterized in this population.
Methods
Using the IBM MarketScan database (2016-2021), we conducted a retrospective cohort study of adult patients with brain metastases who underwent initial treatment with craniotomy, stereotactic radiosurgery (SRS), or whole-brain radiation therapy (WBRT), identified using ICD-10 and procedural codes. Patients required 12 months of enrollment before treatment and discharge either to home or home health. Outpatient rehabilitation within 30 days of treatment was identified by physical, occupational, or speech therapy procedural codes. Emergency department (ED) visits within 90 days were identified by service location. Time from treatment to end of enrollment for any reason (ex: death, insurance loss, change to Medicare) was calculated. Multivariate logistic and linear regression were performed, adjusting for age, sex, region, and treatment modality, with significance set as p < 0.05.
Results
Among 10,419 patients, 632 (6.1%) received outpatient rehabilitation. Rehabilitation was associated with increased likelihood of ED visits within 90 days (OR 1.26 95% CI 1.04-1.50, p = 0.014). Compared to craniotomy, patients undergoing SRS (OR 0.58 95% CI 0.42-0.80, p = 0.001) or WBRT (OR 0.58 95% CI 0.48-0.72, p < 0.001) were less likely to receive rehabilitation. Longer inpatient length of stay was associated with increased rehab utilization (OR 1.10/day, 95% CI 1.06-1.14, p < 0.001). Rehabilitation was associated with longer post-treatment enrollment (+38.6 days, p = 0.023).
Discussion
Brain-metastases patients receiving outpatient rehabilitation appear more clinically complex, with increased ED utilization, longer inpatient stays, and associated postoperative status. Despite this, they demonstrate longer post-treatment enrollment, suggesting a potential benefit and supporting broader consideration of rehabilitation and further investigation of potential socioeconomic or clinical influences on its use.