How different is the care of terminal pancreatic cancer patients in inpatient palliative care units and acute hospital wards? A nationwide population-based study.

Jack P Wang,Shinn-Jang Hwang,Chen-Yi Wu,Chung-Pin Li,I-Hsuan Hwang,Yi-Ping Hung,Chien-Hui Kao

doi:10.1186/s12904-016-0075-x

Abstract

BackgroundInpatient palliative care is important for patients with terminal pancreatic cancer. However, the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer have not been explored in a population-based study.MethodsThis population-based nationwide study was conducted using data from the Taiwan National Health Insurance database to analyze the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer. We identified 854 patients with terminal pancreatic cancer, who had received in-hospital end-of-life care between January 2003 and December 2006. These patients were then sub-divided and matched 1:1 (using propensity score matching) according to whether they received inpatient palliative care (n = 276) or acute hospital care (n = 276). These groups were subsequently compared to evaluate any differences in the use of aggressive procedures, prescribed medications, and medical costs.ResultsInpatient palliative care was typically provided by family physicians (39 %) and oncologists (25 %), while acute hospital care was typically provided by oncologists (29 %) and gastroenterologists (24 %). The inpatient palliative care group used natural opium alkaloids significantly more frequently than the acute hospital care group (84.4 % vs. 56.5 %, respectively; P < 0.001). The inpatient palliative care group also had shorter hospital stays (10.6 ± 11.1 days vs. 20.6 ± 16.3 days, respectively; P < 0.001), fewer aggressive procedures, and lower medical costs (both, P < 0.005).ConclusionsCompared to patients in acute hospital wards, patients with pancreatic cancer in inpatient palliative care units received more frequent pain control treatments, underwent fewer aggressive procedures, and incurred lower medical costs. Therefore, inpatient palliative care should be considered a viable option for patients with terminal pancreatic cancer.

Highlights

Inpatient palliative care is important for patients with terminal pancreatic cancer
Baseline characteristics Among the 854 terminally ill patients with pancreatic cancer that we identified, 276 (32 %) patients were treated in inpatient palliative care units (173 men and 103 women; mean age = 68.6 years) and 578 (68 %) were treated at acute hospital wards (354 men and 224 women; mean age = 67.5 years) (Table 1)
The inpatient palliative care group was typically managed by family physicians (39 %) and oncologists (25 %), whereas the acute hospital care group was typically managed by internal medicine physicians (39 %, P < 0.001), who were generally gastroenterologists (24 %)

Summary

Introduction

Inpatient palliative care is important for patients with terminal pancreatic cancer. Supportive care is the treatment given to prevent, control, or relieve complications and side effects and to improve the patient's comfort and quality of life [4]. Hospice programs typically use a multidisciplinary approach, which includes the services of doctors, nurses, social workers, and clergy, in order to offer holistic care to patients. Based on this comprehensive care, it has been reported that patients who receive hospice care experience a better quality of life, compared to patients with similar conditions who receive conventional care [5]

Objectives

Methods

Results

Conclusion