Functional Stratification and Long-Term Care Service Patterns among Discharged Patients with Cancer: A Retrospective Study from Taiwan.

Abstract

Background: As cancer survival improves, a growing number of patients experience functional decline and require supportive care and long-term care after hospitalization. However, the relationship between functional severity and post-discharge long-term care utilization in patients with cancer remains insufficiently characterized. This study examined long-term care service patterns across functional severity levels, as classified by a Case-Mix System, among hospitalized patients with cancer undergoing discharge planning.

Methods: We conducted a retrospective single-center study of adult patients with cancer who received structured discharge planning at a tertiary hospital in Taiwan between January and December 2024. Discharge outcomes and applications for government-funded long-term care services were described for the full cohort. Exploratory multivariable analyses were restricted to patients who applied for long-term care and had complete Case-Mix System assessment data. Modified Poisson regression with robust variance was used for binary service outcomes, Poisson regression for the number of requested service types, and log-linear regression for length of stay.

Results: Among 207 hospitalized patients with cancer who received discharge planning, 141 (68.1%) returned home, 26 (12.6%) were transferred to long-term care facilities, 1 (0.5%) was transferred to another hospital, and 39 (18.8%) died during hospitalization. Of 167 patients discharged home or to care facilities, 75 (44.9%) applied for long-term care services. Among applicants, 19 (25.3%) had mild disability, 36 (48.0%) moderate disability, and 20 (26.7%) severe disability according to Case-Mix System categories. Long-term care utilization showed a non-linear pattern across functional strata. After adjustment for age, sex, and length of stay, moderate disability was associated with a higher number of requested service types than mild disability (adjusted relative risk [aRR] 1.47, 95% CI 1.16-1.87; p = 0.001). Severe disability was associated with greater respite care use (aRR 2.40, 95% CI 1.40-4.09; p = 0.001), lower home-care use (aRR 0.40, 95% CI 0.17-0.95; p = 0.038), and longer hospitalization (ratio 2.82, 95% CI 1.71-4.65; p < 0.001).

Conclusions: Functional stratification using a Case-Mix System was associated with distinct long-term care service patterns among discharged patients with cancer. Moderate disability was linked to broader multi-service needs, whereas severe disability was more strongly associated with respite-oriented care and prolonged hospitalization. In this single-center exploratory cohort, these findings support further validation of functional stratification approaches for post-discharge cancer care transitions.