Trends in inpatient palliative care utilization among adolescents and young adults with metastatic cancer.

Abstract

12084 Background: Adolescents and young adults (AYA) with advanced cancer, including metastatic cancer, have a unique set of medical, social and psychological needs and often experience several disparities in cancer care when compared with children and older adults. Despite recommendations for early integration of palliative care for patients with serious illnesses, age-appropriate interventions and teams specifically designed for this age group are limited. Objective: To determine the trends in inpatient palliative care utilization as well as associated factors and clinical outcomes among AYA with metastatic cancers in the United States between 2008-2021. Methods: A retrospective longitudinal study using the National Inpatient Sample database (2008-2021) was conducted. We examined trends in the prevalence of palliative care utilization in the cohort, as well as sociodemographic and hospital-level factors associated with palliative care utilization. Using Joinpoint regression and multivariable logistic regression, we examined trends and factors associated with palliative care utilization, as well as specific clinical outcomes including inpatient mortality, length of stay, and total hospital costs. Results: In this period, 604,856 hospitalizations were recorded for AYA with metastatic cancer. Overall, palliative care utilization was recorded in 10.6% of these encounters and increased over time from 3,036 to 16,568 per 100,000 admissions (p-trend <0.001). The adjusted prevalence rate of palliative care utilization increased by an annual percentage change (APC) of 15.9% from 2010 to 2015. However, from 2015 to 2021, no significant changes were observed. Females with metastatic cancer had 18% higher odds (Adjusted odds ratio (AOR):1.18; 95% CI: 1.12-1.24) of receiving palliative care compared to male patients after we adjustments had been made for potential confounders. Non-elective admissions were associated with four times higher odds (AOR: 3.99, 95% CI: 3.68-4.32) of receiving palliative care compared to elective admissions. Palliative care utilisation was associated with higher odds of longer hospital stay (9.3 vs 6 days, β: 3.29, 95% CI: 3.07-3.50) and increased hospital expenditure ($107,758 vs $78,255, β: -29,747, 95% CI: 26,190 - 33,304). A significantly increased odds of palliative care utilization was observed in those who died during the hospital admission (AOR: 16.16; 95% CI: 14.8-17.6). Conclusions: Palliative care utilization has been increasing over the earlier part of the decade but has stalled since 2015 among AYA with metastatic cancer. In the AYA group with metastatic cancer, palliative care appears to be utilized majorly in the sickest patients closer to the end of life. This represents an area of future research and interventions on earlier integration of palliative care and its impact on quality of life and hospital outcomes in this patient population.