Evaluating the role of palliative care in emergency department opioid use among advanced cancer patients.

BACKGROUND

Patients with advanced cancer often experience severe symptoms that significantly impact their quality of life, leading to frequent emergency department visits for pain management. These visits not only diminish patient quality of life, but also impose substantial costs on the healthcare system. While palliative care (PC) has been shown to improve quality of life in cancer patients, its impact on reducing ED utilization for pain remains unclear. This study aimed to evaluate the relationship between PC and ED utilization for pain management in advanced cancer patients within a large integrated healthcare system.

METHODS

We conducted a retrospective cross-sectional study involving adults aged 18 + diagnosed with stage IV cancer who died within 1 year of diagnosis, stratified by outpatient PC enrollment. Data were obtained from the Kaiser Permanente Northern California database, from January 1, 2015, to June 30, 2022. Multivariable Poisson regression models were used to analyze the prevalence of any opioid use during ED visits and cumulative ED visits with opioid use, adjusting for socio-demographics, clinical characteristics, and high-dimensional propensity scores.

RESULTS

The study included 4739 stage IV cancer patients with a total of 12,727 ED visits during their final year of life. Of these, 2243 (47%) received PC. Patients receiving PC had a 24% to 31% lower prevalence of any opioid administration during ED visits across different models, adjusting for baseline characteristics. Additionally, PC was associated with lower cumulative number of ED visits with opioid administration (PRR 0.83, 95% CI, 0.77-0.89).

CONCLUSION

Our study highlights the significant role that PC can play in reducing ED utilization for pain management needs among advanced cancer patients, improving quality of life and alleviating healthcare burdens. These findings underscore the importance of prioritizing access to PC and future research should focus on prospective studies to further explore the causal relationships and optimize PC delivery across diverse healthcare settings.