Palliative care utilization and disparities among adults with advanced cancer hospitalized for sepsis: A National Inpatient Sample analysis (2018–2021).

Abstract

e23194 Background: Sepsis is associated with high inpatient mortality, particularly among patients with advanced cancer. Although disparities in palliative care utilization are well described in oncology, palliative care delivery has been studied primarily in outpatient or elective settings. Less is known about inpatient palliative care use during acute septic hospitalizations in this population. We evaluated sociodemographic and regional disparities in inpatient palliative care utilization and associated outcomes among adults with advanced cancer hospitalized for sepsis. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2018–2021), including adults with advanced cancer hospitalized primarily for sepsis. Inpatient palliative care utilization was identified using ICD-10 diagnosis codes. Outcomes included aggressive life-sustaining treatments, in-hospital mortality, length of stay (LOS), total hospital charges, and discharge disposition. Multivariable regression models examined adjusted associations between palliative care use, patient sociodemographic factors, and hospital characteristics, accounting for the complex survey design. Results: Inpatient palliative care utilization varied by race, insurance status, hospital region, and hospital characteristics. Black patients had higher odds of receiving palliative care and lower in-hospital mortality compared with White patients, while zip-code income quartile was not associated with palliative care use. Palliative care was associated with lower odds of aggressive treatment, shorter LOS, and differences in hospital charges. Patients receiving palliative care had higher in-hospital mortality, consistent with preferential use among patients with greater illness severity. Non-White patients experienced longer hospital stays and higher charges independent of palliative care use, with substantial regional variation. Conclusions: In this national cohort of adults with advanced cancer hospitalized for sepsis, inpatient palliative care utilization was more strongly associated with hospital and regional characteristics than with neighborhood income. Higher palliative care use and lower in-hospital mortality among Black patients contrasts with prior oncology studies, suggesting palliative care delivery during acute critical illness may differ from outpatient care. These findings support more consistent integration of inpatient palliative care among adults with advanced cancer hospitalized for sepsis. Multivariable adjusted association of inpatient palliative care with outcomes. Outcome Estimate 95% CI Aggressive treatment OR 0.66 (0.64–0.69) <0.001 In-hospital mortality OR 4.23 (4.06–4.41) <0.001 Home discharge OR 0.41 (0.39–0.42) <0.001 LOS −6.2% (−7.4 to −5.0) <0.001 Total charges 2.0% (0.5–3.5) 0.011