End-of-life outcomes of patients with advanced cancer enrolled in palliative care.

Abstract

12030 Background: Palliative Care (PC) integration improves end-of-life (EOL) outcomes for patients with advanced cancer. However, there is limited evidence in real world settings of the impact of PC enrollment on EOL outcomes and the presence of racial disparities in PC enrollment. We sought to understand how PC enrollment differs between certain patient demographics and whether enrollment affects EOL outcomes in a large integrated health system. Methods: This retrospective cross-sectional study included adults 18 years and older diagnosed with Stage IV solid cancers who died within 1 year of diagnosis at 21 cancer centers within Kaiser Permanente Northern California between 2018-2020. Demographics, clinical variables and EOL outcomes were compared by PC enrollment status. Categorical and continuous comparisons were made using Chi-squared and t-tests, respectively. Results: Among 3,575 patients diagnosed with stage IV solid cancers who died within 1 year of diagnosis (mean age 73.2), 52.8% were male; 8.2% were Black, 11.0% Hispanic, 12.3% Asian, and 67.7% non-Hispanic White. Most patients (93.0%) selected English as their preferred language. The most common cancer subtypes were thoracic (33.2%), upper GI (32.4%), and lower GI (10.6%). Overall, 1613 patients (45.1%) were enrolled in PC. Baseline demographics were similar between the PC and no-PC groups including gender (p = 0.58), race (p = 0.32), and preferred language (p = 0.23). There was a difference in mean age between groups (72.0 vs. 74.2, p < 0.01). Patients enrolled in PC were more likely to enroll in hospice (42.9% vs. 25.7%, p < 0.01, Table) and less likely to be hospitalized in the last 30 days of life (35.5% vs. 45.7%, p < 0.01, Table). Short hospice stays (< 3 days) were uncommon in both groups, and there was no statistically significant difference between groups (4.5% vs. 5.4%, p = 0.49, Table). There was no significant difference in the proportion of patients with multiple ED visits in the last 30 days of life between groups (21.0% vs. 21.8%, p = 0.56, Table). Conclusions: PC enrollment is associated with significant improvement in some EOL outcomes with higher rates of hospice enrollment and lower rates of hospitalization at the EOL. These outcomes were seen without racial disparities in PC enrollment. Future studies are needed to assess other outcomes related to goal-concordant care and to determine which patients benefit most from PC enrollment. [Table: see text]