158 No Cure, No Comfort: An Urban Center Experience With Palliative Care for Hospitalized Colon Cancer Patients, 2010–2017

Abstract

INTRODUCTION: Palliative care is integral to cancer treatment. Our goal was to investigate the frequency of palliative care service contact for colon cancer patients and factors associated with their involvement. METHODS: We carried out a retrospective analysis of all colon cancer patients diagnosed at our university-affiliated hospital between 1/1/2010 and 12/31/2017. We used Fisher's exact test to find statistically significant differences in proportions of patients seen by the palliative care service based on sex, race, insurance type, cancer stage, surgical intervention, and chemotherapy administration, hospitalization history, and vital status. Bayesian univariate logistic regression models were fit to each variable to give the probability of palliative care use for each. RESULTS: We identified 655 patients diagnosed with colon cancer at our institution, including 361 (55%) women, 280 (43%) with Stage III or IV disease, and 156 (25%) dead at time of last contact. Most were diagnosed as inpatients (385/655; 59%) and hospitalized for any cause (612/655; 93%). Those diagnosed as inpatients had poorer survival for the first 6 years after diagnosis compared to their counterparts (Figure 1). Only 105/612 (17%) admitted for any cause were evaluated by the palliative care team—regardless of sex, race, insurance type, or cancer stage—while 484/612 (79%) underwent surgical intervention and 151/612 (25%) received chemotherapy. Most patients with Stage III and IV disease were more likely to undergo surgery (214/285; 75%) than not, yet were less likely to receive chemotherapy (150/285; 53%) and palliative care team contact (214/285; 75%). Results are summarized in Tables 1 and 2. CONCLUSION: The lack of contact with palliative care teams is concerning given both the poorer survival among those diagnosed as inpatients as well as the rate of all-cause admissions. Additionally, the preponderance of surgical interventions without chemotherapy or palliative care in Stage III to IV disease is inconsistent since aggressive treatments typically involve the former while conservative plans should include the latter. The underutilization of palliative care teams may be rooted in lack of staffing, misconceptions that providers and patients have about palliative care, or lack of coordination among specialists. Providers must be mindful of the utility of palliative care specialists and aim to include them earlier in the care of patients at all stages of disease.