The impact of early versus late palliative care referral (PCR) on healthcare utilization in pancreatic cancer patients: A single-center retrospective study.

Abstract

12092 Background: Pancreatic cancer is one of the most aggressive malignancies, imposing substantial physical, psychosocial, and financial stress that significantly compromises patients’ quality of life (QOL). Despite its importance, only limited data exists on the optimal timing of a palliative care referral (PCR) in the course of pancreatic cancer. We propose that early PCR offers a proactive approach that not only alleviates symptom burden and improves QOL but also reduces healthcare utilization (HCU) and associated costs. Methods: We performed a retrospective analysis for patients diagnosed with pancreatic cancer at Allegheny Health Network from January 2015 to January 2024. Based on the timing of PCR from the diagnosis of pancreatic cancer, patients were categorized into early PCR ( < 3 months), and late PCR ( > 3 months) cohorts. HCU metrics were compared between the two cohorts including the number of emergency department (ED) visits, hospital admissions and intensive care unit (ICU) admissions, using Mann Whitney U test. Statistical analysis was performed using SAS 9.4, with an alpha level of 0.05. Results: From 2015- 2024, 2020 patients were diagnosed with pancreatic cancer and only 309 patients received a PCR. The patients who got a PCR had a median age of 66 years, 56% of them were males and 97% were non-Hispanic. Among these, 172 patients had an early PCR, and 137 patients had a late PCR. The patients in the early PCR group were generally non-Hispanic males with a mean age of 68 years, while those in the late PCR group being non-Hispanic males with a mean age of 64 years. The median number of ED visits was significantly higher in the late PCR cohort compared to the early PCR cohort, {3 [Interquartile range (INR)2-5] versus 2 [INR1-3] respectively, p < 0.0001}. 52.55% patients in the late PCR cohort had an ED visit due to pain, compared to only 37.79% patients in the early PCR cohort (p < 0.009). 36.63% patients in the early PCR group had an ICU admission as compared to 62.04% patients in the late PCR group (p < 0.0001). Similarly, early PCR group had a significantly lesser number of hospital admissions, 2 (INR 1-3), than the late PCR group, 4 (INR 1-10), p < 0.0001.While Chemotherapy use in the last 2 months from death was observed in 30.66% patients with late PCR and 29.07% of patients with early PCR, the difference was not statistically significant. Conclusions: Our study shows the use of early PCR in reducing aggressive care towards the end of life including ED visits and hospital and ICU admissions. Due to the advanced nature of pancreatic cancer at presentation, early integration of palliative medicine into comprehensive cancer care would be beneficial for improving the QOL of patients and would also reduce the HCU, enhancing economic sustainability of care. Further research is needed to show the effect of early PCR on the psychological stress experienced by pancreatic cancer patients.