Impact of early palliative care on healthcare utilization in patients with advanced lung cancer in the final year of life.

Abstract

239 Background: The benefits of early palliative care (PC) in advanced lung cancer are well established, including both increased quality of life and decreased hospital costs at end-of-life. We performed a quantitative and preliminary qualitative analysis on end-of-life healthcare utilization of patients with advanced lung cancer in their final year of life to explore the impact of early vs. late PC. Methods: We retrospectively reviewed claims and clinical data of 54 patients with advanced lung cancer who died between 2021 and 2022 under Northwestern Medicine’s Accountable Care Organization. We classified patients as having received PC if a diagnosis code (Z51.5) appeared in claims data or if the patient’s treatment team included a PC specialist. We identified patients as having received “early” PC if their first PC visit was 90 or more days before death. Statistical analysis was performed with Fisher exact tests. Results: Forty-three (80%) patients had a PC code on claims data, while 38 (70%) had a PC team member identified within the electronic medical record. Patients receiving PC were less likely to visit the emergency department in their last 6 months of life (71% vs. 94%, p = 0.03) and more likely to utilize hospice (53% vs. 44%, p = 0.27) compared to patients without PC. Patients receiving early vs. late PC were more likely to have initiated PC as an outpatient (67% vs. 31%, p = 0.02), more likely to utilize hospice (57% vs. 44%, p = 0.21), more likely to have shorter intensive care unit stays in their last month of life (average of 10 vs. 25 days), and significantly less likely to undergo systemic treatment in their last 30 days of life (24% vs. 56%, p = 0.02) or die in the hospital (29% vs. 56%, p = 0.04). From a preliminary qualitative review, patients receiving early PC may have engaged in increased communication about clinical prognosis and goals of care, while their PC teams provided more detailed documentation of conversations about end-of-life wishes and advanced directives. Conclusions: Our data demonstrate a difference in end-of-life healthcare utilization between patients who received early vs. late PC. Limitations of this study include its small sample size and the nature of retrospective cohort studies. Qualitative evaluation is ongoing to investigate the impact of early oncologist-driven goals of care discussions on end-of-life healthcare utilization as well as moderators of early palliative care’s positive impact.