An assessment of end of life care among patients with gastrointestinal cancers who died inpatient at an academic hospital.

Abstract

e24030 Background: Studies suggest that most patients with cancer prefer to die at home. Despite this established preference, many cancer patients die in hospitals. We sought to determine the clinical scenarios which were associated with in-hospital death, with a focus on the use of immunotherapy and clinical trials in the days leading up to death. Methods: We performed chart reviews on all patients treated in the gastrointestinal oncology group at NYU Langone Cancer Center who died in NYU Langone Hospital from 8/1/2023 to 7/31/2024. We characterized demographic information, cancer treatments, palliative care consultation, and invasive interventions done within three months of death for each patient. We explored associations between treatments and use of palliative and hospice care in the days leading up to in-hospital death. Results: We identified 92 patients with GI cancers who died inpatient between August 2023 and July 2024. The median age was 68; the most common cancers were pancreatic cancer 46%, colon cancer 17%, and cholangiocarcinoma 11%; 62% were male and 38% were female; and race distribution consisted of 62% White, 14% Asian, 12% Hispanic, and 12% Black. The Table details use of palliative care, hospice, clinical trials, and immunotherapy in our sample. We found that patients who received immunotherapy were significantly more likely to have been seen by palliative care prior to final hospitalization than those who did not receive immunotherapy (66% vs 36%, p=0.01). Patients started on clinical trials were also more likely to utilize outpatient palliative care (67% vs 41%, p=0.05). There was no difference between patients who received immunotherapy and those who did not among code status at hospital admission, number of ICU stays, and use of inpatient hospice care. The same is true of patients who enrolled in clinical trials compared to patients who did not. Conclusions: We found that the rate of palliative care utilization prior to hospitalization was low (< 50%) across all patients who die as inpatients, but a substantial number (15%) had referrals to palliative care which did not translate into palliative consultations. We noted that only approximately half of patients transitioned to inpatient hospice, which had no association with immunotherapy use or clinical trial participation. Prior to inpatient death, immunotherapy and clinical trials were associated with more palliative care use. Notably, more needs to be done to involve palliative care early in the management of cancer patients with poor prognosis. Yes No Palliative care referral 56 (61.5%) 35 (38.5%) Attended outpatient palliative care meeting 42 (46.2%) 49 (53.8%) Hospice referral 12 (13.2%) 79 (86.8%) Transitioned to inpatient hospice 50 (55.6%) 40 (44.4%) Clinical trial enrollment 26 (28.6%) 65 (71.4%) Clinical trial treatment started 18 (19.8%) 73 (80.2%) Immunotherapy usage 59 (64.8%) 32 (35.2%)