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.