Impact of inpatient palliative care consultation on end-of-life care among patients with esophageal cancer.

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502 Background: Esophageal cancer is an aggressive malignancy with a high global prevalence. Patients often suffer from various debilitating symptoms like dysphagia and cachexia, particularly with more advanced stage disease. Most patients continue to receive aggressive interventions until terminal stages of disease without timely initiation of formal palliative care (PC). We sought to investigate the impact of formal inpatient palliative care consultation on end-of-life (EOL) care among patients with esophageal cancer. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal cancer utilizing ICD-10 codes C15.x from 2016 to 2020. Hospitalizations with documented inpatient mortality events were extracted and stratified based on reception of PC consultation (ICD-10 code Z51.5). Demographic and clinical data were analyzed using chi-squared tests and independent sample t-tests. A threshold of p-value less than 0.05 was set to determine statistical significance. Results: A total of 17,745 patients with esophageal cancer were included, of which 10,370 (58.4%) received PC consultation. Patients that received PC consultation at EOL were more likely to have higher comorbidities per CCI. No significant difference between age and sex was observed between the two cohorts. Patients who received PC consultations at EOL had higher rates of Do Not Resuscitate (DNR) code status (78.1% vs 43.2%, p <0.001) and lower rates of aggressive interventions such as chemotherapy (0.9% vs 1.6%, p<.001), blood transfusions (12.3% vs 18%, p<.001), and mechanical ventilation (28.5% vs 41%, p<0.001). No significant difference was observed in the rates of vasopressor use between the two groups (p=0.83). Hospitalizations with PC consultations were associated with significantly lower total hospitalization cost ($97,879 vs $146,128, p<.001). Conclusions: Inpatient PC consultations among patients with esophageal cancer were associated with lower rates of aggressive interventions and higher rates of DNR code status in addition to significantly lower total hospitalization costs. These findings underscore the importance of inpatient PC consultation at the EOL in helping minimize aggressive interpretation and facilitate a greater focus on comfort and quality of life. No PalliativeN=7375 PalliativeN=10370 p-value Age (in years) 67.58 ± 10.9 67.58 ± 10.9 .98 CCI 9.1 ± 3.5 9.4 ± 3.3 <.001 Mean length of stay (days) 8.9 ± 14.9 7.5 ± 11.3 <.001 Total Charges 146128 ± 321830 97879 ± 195868 <.001 DNR 3170 (43.2%) 8100 (78.1%) <.001 Blood transfusion 1320 (18.0%) 1280 (12.3%) <.001 Mechanical ventilation 3015 (41.0%) 2960 (28.5%) <.001 Vasopressor 585 (8.0%) 835 (8.1%) 0.83 Chemotherapy 115 (1.6%) 95 (0.9%) <.001