Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers.

BACKGROUND

Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable.

OBJECTIVE

The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC.

DESIGN

Retrospective, cross-sectional analysis of data from the National Inpatient Sample.

SETTING AND SUBJECTS

Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013.

MEASUREMENTS

In-hospital length of stay (LOS), morbidity, mortality, and total charges.

RESULTS

A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4% vs. 44.1%, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95% CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79% lower odds of receiving PC (OR = 0.21, 95% CI: 0.20-0.22, p < 0.001).

CONCLUSIONS

Among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.