Clinical and economic outcomes associated with inpatient palliative care in hospitalized patients with cancer: A systematic review and meta-analysis.

Abstract

e24072 Background: Inpatient palliative care (IPC) is increasingly utilized for hospitalized patients with cancer to improve symptom management and support goal-concordant care. While much of the evidence supporting palliative care has focused on the outpatient setting, the clinical and economic outcomes of IPC remain less well defined. Existing studies suggest that IPC may influence outcomes beyond symptom control, including inpatient mortality (IM), hospital length of stay (LOS) and costs of care. We conducted a systematic review and meta-analysis to evaluate the association between IPC and clinical and economic outcomes among hospitalized patients with cancer. Methods: We performed a systematic search of PubMed in November 2025 to identify administrative database studies evaluating IPC among hospitalized patients with cancer. Two reviewers screened articles and discrepancies were resolved by consensus. Data analysis was conducted using a random-effects model. Pooled estimates with 95% confidence intervals (CI) were calculated, and heterogeneity was assessed using the I² statistic. Results: From 984 studies initially identified, 18 studies met our inclusion criteria, encompassing a total of 1,731,596 hospitalized cancer patients. Overall, IPC was associated with higher odds of IM compared with no IPC (OR 6.45, 95% CI 4.87–8.55; P < 0.00001; I² = 100%), with no significant difference between high and low IPC utilization subgroups (P = 0.16). For LOS, no significant difference was observed between the IPC and no IPC groups (MD −0.02 days, 95% CI −0.78 to 0.73; P = 0.95; I² = 100%), with no evidence of subgroup differences between high and low IPC utilization subgroups (P = 0.92). Analysis of hospital costs demonstrated no significant difference between the IPC and no IPC groups (SMD 0.03, 95% CI −0.15 to 0.20, P = 0.78, I² = 95%). In contrast, IPC was associated with lower hospital charges compared with no IPC (MD −4,976 USD, 95% CI −7,129 to −2,823; I² = 86%). Conclusions: IPC was associated with significantly higher IM compared with no IPC. This finding is best explained by confounding by indication, as IPC is more frequently delivered to patients with a higher baseline mortality risk. Despite higher mortality in the IPC group, IPC involvement was not associated with a significant difference in LOS, suggesting that IPC does not meaningfully prolong or shorten inpatient admissions at the population level. Economic outcomes differed by metric; while no significant differences in hospital costs were observed, IPC was associated with lower hospital charges, likely reflecting variability in billing and reimbursement practices. Reduced charges associated with IPC may reflect lower utilization of high-intensity interventions. These findings highlight the potential clinical and economic implications of broader IPC involvement for hospitalized cancer patients.