Inpatient palliative care utilization and outcomes among decedent patients with metastatic cancer in the U.S.

Abstract

11119 Background: Palliative care (PC) is a key component of high quality cancer care, especially at the end of life. However, real world national data describing inpatient PC utilization remain limited. We evaluated patterns of PC use and associated outcomes among decedent patients with metastatic cancer in the U.S. Methods: We conducted a cross-sectional analysis of the 2021–2023 National Inpatient Sample of decedent patients with metastatic cancer. Palliative care, cancer type, and metastatic status were identified using ICD-10 codes. Patient characteristics included age, sex, race, comorbidity burden, insurance status, and household income. Hospital characteristics included location (urban vs rural) and ownership (public, private not-profit, and private invest-own). Outcomes included length of stay (LOS), inpatient procedures, and total costs. Factors associated with palliative care use and adjusted mean differences in outcomes were estimated. Results: An estimated 52,841 hospitalizations of decedent patients with metastatic cancer were identified, with 34,955 (66.2%) involving palliative care. PC utilization varied by cancer type (Table) and increased over time (aOR per year 1.15; 95% CI 1.12–1.18). PC use was independently associated with older age, female sex, private insurance, higher neighborhood income, and care at private not-for-profit hospitals (all p<0.001). PC was associated with fewer inpatient procedures (adjusted mean difference −1.38; 95% CI −1.45 to −1.31), shorter LOS (−1.25 days; 95% CI −1.45 to −1.06), and lower total costs (−$10,557; 95% CI −$11,421 to −$9,694). Reductions in procedures, LOS and costs were significant across most cancer types. (Table). Conclusions: Inpatient PC was associated with lower care intensity and costs across cancer types among decedent patients with metastatic cancer. Yet, about one third never received PC, highlighting a major end-of-life care gap and the need for earlier, more equitable integration to improve value based oncology care. Palliative care utilization and outcomes by major cancer type. Cancer Type PC use Adjusted Procedures difference Adjusted Cost difference ($) Adjusted LOS difference (days) Breast 2646 (66.7%) -1.47 (-1.70,-1.24) -12512 (-16301, -8722) -1.90 (-2.63,-1.17) Colorectal 2932 (65.8%) -1.75 (-1.49,-2.00) -12231 (-15261, -9201) -1.09 (-1.83,-0.35) Lung 8942 (67.9%) -1.14 (-1.28,-1.00) -6341 (-7894, -4968) -0.90 (-1.24,-0.56) Prostate 1897 (62.3%) -1.24 (-1.52,-0.97) -9736 (-12915, -6558) -0.88 (-1.82,0.05)* Pancreas 2574 (68.4%) -1.46 (-1.72,-1.21) -7396 (-9525, -5266) -0.39 (-0.94,0.17)* Kidney 936 (66.3%) -1.72 (-2.20,-1.23) -12353 (-17623, -7082) -1.93 (-3.11,-0.75) Liver 1362 (67.8%) -0.87 (-1.24,-0.51) -8896 (-13426, -4367) -1.27 (-0.33,-2.20) All p<0.001 unless noted with *.