Analysis of Inpatient Palliative Care Consultations for Patients With Metastatic Prostate Cancer.

OBJECTIVE

To characterize the use of palliative care for patients with metastatic prostate cancer and identify its associations with costs, hospital course, and discharge.

MATERIALS AND METHODS

Using the National Inpatient Sample database from 2012 to 2013, we identified 99 070 patients with metastatic prostate cancer and analyzed the data from their hospital admissions using descriptive statistics, χ analysis, and regression modeling.

RESULTS

Palliative care services were consulted in 10.4% (10 300) of metastatic prostate cancer admissions. These admissions were associated with nonelective origin, acute complications, and reduced surgical procedures and chemotherapy. Patients in private, investor-owned hospitals had a 51.6% less consultations ( < .001), while nonprofit and government, nonfederal hospitals had 4.7% and 7.8% more consultations ( < .001). Median costs and charges were only marginally less (2.1% and 5.6%, respectively, < .001), length of stay was 22% higher ( < .001), and in-house mortality was 147.2% higher in the consultation group ( < .001). Controlling for other factors, patients seen by palliative care were more likely to have do-not-resuscitate orders (odds ratio [OR]: 5.25, < .001) and be transferred to another facility like hospice (OR: 3.90, < .001) or to home health (OR: 3.85, < .001).

CONCLUSIONS

Palliative care consultation could improve care for patients with metastatic prostate cancer in a different manner than observed in other diseases. With our characterization of the incidence and patient and hospital factors, we can conclude that there is room to expand palliative care's role beyond uninsured patients in large, urban teaching hospitals.