J. M. Ruck1, J. K. Canner1, T. J. Smith2, F. M. Johnston1 1Johns Hopkins School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins Hospital,Sidney Kimmel Comprehensive Cancer Center,Baltimore, MD, USA
Introduction:
The field of oncology has led palliative care (PC) utilization and demonstrated how PC improves patient quality of life. Yet, the frequency of and factors associated with PC use during oncology-related hospitalizations remain unknown.
Methods:
Using the National Inpatient Sample dataset, we identified 124,186 hospitalizations 2012-2014 for patients with a high risk of in-hospital mortality (DRG risk of mortality=3-4) and a primary diagnosis of malignancy (melanoma, breast, colon, gynecologic, prostate, male genitourinary (GU), head/neck, urinary tract, non-colon gastrointestinal, lung, brain, bone/soft tissue, endocrine, or non-lung thoracic). Univariate analyses were stratified by malignancy type. PC use was identified using the V66.7 ICD-9 code. Change in PC use over time was assessed using linear regression. The number of secondary diagnoses, median cost of hospitalization, and frequency of palliative procedures, surgical procedures, and in-hospital death were compared by PC use. Patient factors associated with the cost of hospitalization were identified using multivariable linear regression.
Results:
PC use increased 2012-2014 for all malignancy types except brain cancer. Patients utilizing PC had more secondary diagnoses than those who did not (median 12-17 vs. 11-15, all p<0.001), a higher frequency of palliative procedures (4-36% vs. 0-35%, all p<0.01 except non-lung thoracic), a lower frequency of operative procedures (4-33% vs. 34-79%, all p<0.001), a higher rate of in-hospital death (30-45% vs. 4-10%, all p<0.001), a lower total cost for the hospitalization (median, in thousands: $14-61 vs. $33-98, all p<0.01 except male GU). PC was associated with a shorter or similar – but not longer – length of stay vs. no PC. In an adjusted analysis, the cost of hospitalization was associated with patient sex (female vs. male, $5,248 lower), race (African American vs. other, $12,773 lower), age (per year older, $720 lower), operative procedure(s) (had vs. didn’t have, $33,149 higher), in-hospital death (died vs. alive, $26,269 higher), length of stay (per day longer, $9,965 higher), and PC (PC vs. no PC, $13,191 lower) (all p<0.001).
Conclusion:
In summary, inpatient PC utilization has increased for patients with a high predicted risk of in-hospital mortality, though PC was disproportionately used for patients who experience in-hospital death. PC was associated with lower utilization of surgical procedures, shorter length of stay, and lower hospitalization cost. Lower hospitalization cost is also seen for patients who are older, female, or African American, suggesting possible disparities in cancer care utilization by age, sex, and race.
