Mojtahedi Zahra, Koo Ja Seol, Yoo Ji, Kim Pearl, Kang Hee-Taik, Hwang Jinwook, Joo Moon Kyung, Shen Jay J
Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea.
Cancer Manag Res. 2021 Oct 2;13:7569-7577. doi: 10.2147/CMAR.S330448. eCollection 2021.
In recent years, palliative care utilization has been increasing while life-sustaining/local procedures have been declining at the end of life. Palliative care utilization widely varies based on tumor type. Limited information is available on inpatient palliative care in colorectal cancer.
This study investigated inpatient palliative care utilization and its association with patient demographics, hospital charges, and procedures among colorectal cancer patients admitted to US hospitals between 2008 and 2017. Receipt of life-sustaining and local procedures and surgeries were also investigated during the ten years.
Data were extracted from the National inpatient sample (NIS) database containing de-identified information from each hospitalization. Codes V66.7 for ICD-9-CM or Z51.5 for ICD-10-CM were used to find palliative care utilization. Data were analyzed using generalized regression with adjustment for variations in predictors. The Compound Annual Growth Rate (CAGR) was calculated for palliative care and procedures over time.
Of the 487,027 colorectal cancer hospitalizations, only 6.04% utilized palliative care. This percentage significantly increased over time from 2.3% in 2008 to 9.3% in 2017 (<0.0001). Palliative care utilization sizably decreased hospital charges by $18,010 per hospitalization (<0.0001) and was positively associated with female gender, severe disease, and age over 80 years (≤ 0.05). Palliative care utilization was inversely associated with using life-sustaining and local procedures and surgeries (<0.0001). Life-sustaining procedures (intubation, infusion of concentrate nutrients, dialysis, and blood transfusion) and surgeries were decreased over time (<0.001).
Palliative care utilization increased over time and was inversely associated with hospital charges and performing procedures among colorectal cancer patients. Our findings warrant further research and interventions to increase palliative care utilization in colorectal cancer.
近年来，姑息治疗的使用率一直在上升，而维持生命/局部治疗在生命末期一直在下降。姑息治疗的使用率因肿瘤类型而异。关于结直肠癌住院患者姑息治疗的信息有限。
本研究调查了2008年至2017年期间美国医院收治的结直肠癌患者的住院姑息治疗使用率及其与患者人口统计学、医院费用和治疗程序的关系。同时还调查了这十年间维持生命和局部治疗及手术的接受情况。
数据从国家住院样本（NIS）数据库中提取，该数据库包含每次住院的去识别信息。使用ICD-9-CM的V66.7编码或ICD-10-CM的Z51.5编码来查找姑息治疗的使用率。使用广义回归分析数据，并对预测变量的差异进行调整。计算了姑息治疗和治疗程序随时间的复合年增长率（CAGR）。
在487,027例结直肠癌住院病例中，只有6.04%使用了姑息治疗。这一比例随时间显著增加，从2008年的2.3%增至2017年的9.3%（<0.0001）。姑息治疗的使用使每次住院费用大幅降低18,010美元（<0.0001），并且与女性、重病和80岁以上年龄呈正相关（≤0.05）。姑息治疗的使用与维持生命和局部治疗及手术的使用呈负相关（<0.0001）。维持生命的治疗（插管、输注浓缩营养素、透析和输血）和手术随时间减少（<0.001）。
姑息治疗的使用率随时间增加，并且与结直肠癌患者的医院费用和进行治疗程序呈负相关。我们的研究结果值得进一步研究和干预，以提高结直肠癌患者姑息治疗的使用率。
