Inpatient palliative care and clinical outcomes in gastric cancer with sepsis: A population-based cohort study.

Abstract

340 Background: Gastric cancer is the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide, with a 5-year survival rate of ~32%. Sepsis substantially worsens outcomes in cancer patients, increasing mortality risk by 3–5 fold. While palliative care is recommended to improve quality of life and align goals of care, its role in gastric cancer patients admitted with sepsis is not well defined. Methods: We conducted a retrospective cross-sectional study using the 2018–2021 National Inpatient Sample. Hospitalized Adults with gastric cancer and coexisting sepsis were identified using ICD-10 codes. The exposure was receipt of a palliative care consult. The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), respiratory failure, mechanical ventilation, shock, length of stay (LOS), and hospitalization charges. Survey-weighted descriptive statistics and multivariable regression analyses adjusted for possible confounders. Results: Among 12,750 weighted hospitalizations for gastric cancer with sepsis, 29.6% received a palliative care consult. In-hospital mortality was higher in the palliative group compared to non-palliative (40.3% vs 22.2%), with palliative care significantly associated with nearly four-fold greater odds of death (OR 3.89, 95% CI 3.18–4.75, p <0.001). Palliative care was also associated with increased risk of acute kidney injury (OR 1.61, 95% CI 1.36–1.91, p <0.001), respiratory failure (OR 1.90, 95% CI 1.58–2.28, p <0.001), mechanical ventilation (OR 1.37, 95% CI 1.03–1.83, p =0.033), and shock (OR 1.84, 95% CI 1.54–2.21, p <0.001). There were no significant differences in length of stay (8.0 vs 8.0 days, p =0.59) or hospitalization charges ($108,795 vs $106,258, p =0.93) between groups. Conclusions: In this nationwide analysis, palliative care consultations in gastric cancer patients with sepsis were associated with higher in-hospital mortality and greater odds of acute complications. These findings likely reflect the fact that palliative care is often initiated later in the hospital course, when patients are already severely ill and stabilization efforts are underway. Consequently, the observed associations may be more indicative of delayed initiation rather than a direct effect of palliative care itself. Future studies should specifically evaluate the timing of palliative involvement- early versus late initiation- to better understand its impact on outcomes in this high-risk population.