Palliative care utilization and acute care outcomes in metastatic prostate cancer in a safety-net health system.

Abstract

e24064 Background: Patients with metastatic prostate cancer (MPCa) experience high symptom burden and frequent emergency department (ED) visits and hospitalizations. Early integration of palliative care (PC) is recommended, yet PC utilization and timing remain variable. We evaluated patterns of PC referral and associated acute care outcomes in a safety-net cohort. Methods: We conducted a single-institution retrospective study of patients with MPCa treated at the University of Illinois Hospital between 2016 and 2025. Patients were identified through the institutional electronic medical record using diagnosis codes and chart review. Patients were categorized by receipt of a documented PC consult (PC vs no PC). Primary outcomes included ED visits, hospitalizations, and ICU admissions after metastatic diagnosis. Early PC was defined as consult within ≤60 days of metastatic diagnosis. Outcomes were summarized using descriptive statistics and compared between groups. Results: Among 184 patients with MPCa, the cohort was predominantly Black (70.3%) and non-Hispanic (82.3%). Insurance coverage was primarily Medicare (51.4%) and Medicaid (26.3%), with 5.1% uninsured. Overall, 74/184 (40.2%) received a documented PC consult. Within the PC cohort, 21/74 (28.4%) received early PC (≤60 days) while 45/74 (60.8%) received late PC (>60 days). The most common indications for PC referral included symptom control (51.4%), pain management (43.1%), and goals-of-care discussions (33.3%). PC was delivered in outpatient and inpatient settings (55.6% and 50.0%, respectively). Acute care utilization was higher among patients receiving PC. PC patients had higher mean ED visits after metastatic diagnosis (1.70 vs 0.92), higher ED utilization (≥1 ED visit: 59.5% vs 37.3%), and higher frequent ED use (≥2 ED visits: 39.2% vs 23.6%). The PC cohort also demonstrated higher mean hospitalizations (1.91 vs 1.14) and a higher proportion experiencing ≥1 hospitalization (67.6% vs 52.7%). ICU utilization was increased among PC patients (≥1 ICU admission: 23.0% vs 10.0%). In a timing analysis among PC patients, late PC referral was associated with higher ED utilization compared with early PC (mean ED visits: 1.91 vs 1.43; ED ≥2 visits: 46.7% vs 28.6%). Additional analyses will be available at presentation if accepted. Conclusions: In this diverse safety-net cohort, patients receiving palliative care demonstrated higher acute care utilization, consistent with referral patterns among higher-acuity and more clinically complex patients. Among PC recipients, late referral was associated with increased ED utilization compared with early PC, highlighting an opportunity for earlier integration of PC and supportive oncology services in MPCa.