Economic impact and mortality outcomes of palliative care integration among cancer patients: Analysis of National Inpatient Sample 2018-2022.

Abstract

12031 Background: While palliative care integration into oncology represents a quality metric, its relationship with mortality outcomes and cost implications remains incompletely characterized. This study evaluates the association between palliative care consultation and healthcare utilization across major cancer types. Methods: We conducted a retrospective analysis using the National Inpatient Sample (2018-2022). Eligible patients included adults with primary diagnoses of lung, breast, prostate, or colon cancer. Palliative care utilization was identified (ICD-10 code Z51.5). Primary endpoints included in-hospital mortality, length of stay (LOS), and total charges. Propensity score matching (1:1 nearest neighbor, caliper 0.2) was used to account for selection bias. Confounding variables included age, race, insurance status, hospital characteristics, and comorbidity burden. Missing data were handled using complete case analysis. Temporal trends were assessed using Cochran-Armitage test. Results: Among 1,104,888 eligible hospitalizations (469,831 lung, 203,857 breast, 204,837 colon, 226,065 prostate), 70,863 in-hospital deaths occurred. Palliative care consultation was associated with reduced LOS (adjusted mean difference: -1.2 days; 95% CI: -1.4 to -1.0; p<0.001) and lower total charges (adjusted mean difference: -$31,947; 95% CI: -$34,521 tor o -$29,373; p<0.001) among deceased patients. Cancer-specific mortality rates with without were: lung (31.26% vs 4.16%, p<0.001), breast (26.72% vs 2.16%, p<0.001), colon (25.60% vs 2.27%, p<0.001), and prostate (27.07% vs 1.98%, p<0.001). Overall palliative care utilization increased from 13.50% to 15.91% (2018-2022; APC: +0.68%; p-trend<0.001). DNR status strongly predicted palliative care utilization (adjusted OR: 4.50; 95% CI: 4.41-4.60; p<0.001). Conclusions: In this large nationwide analysis, palliative care consultation was associated with significant reductions in healthcare utilization and costs among deceased cancer patients. Universal implementation could potentially save 27,744 hospital days and $996.4 million annually, suggesting substantial opportunities for healthcare system optimization. Healthcare utilization outcomes by cancer type and palliative care status. Cancer Type Deaths (N) PC Rate (%) Adjusted Cost Difference* ($) Adjusted LOS Difference* (Days) Lung 41,808 61.45 -32,655 (-35,124, -30,186) -0.94 (-1.12, -0.76) Breast 9,981 60.80 -31,382 (-34,276, -28,488) -0.97 (-1.18, -0.76) Colon 9,667 56.95 -47,079 (-50,612, -43,546) -1.32 (-1.56, -1.08) Prostate 9,407 56.61 -37,099 (-40,388, -33,810) -0.81 (-1.02, -0.60) *Values represent adjusted differences (95% CI) between palliative care and non-palliative care groups. PC = Palliative Care; LOS = Length of Stay.