Incidence of palliative care consultations in end-of-life care among patients with pancreatic cancer in the US.

Abstract

e16302 Background: Integration of palliative care in the treatment plan for a variety of diseases has been shown to improve quality of life, reduce aggressive interventions, and reduce cost burdens. This study aimed to explore the incidence of palliative care consultations in pancreatic cancer patients and determine its influence on the utilizations of aggressive interventions towards end of life. Methods: We conducted a retrospective study using a de-identified national Electronic Health Record (EHR) database, which captured deceased patients between January 1, 2000 to December 21, 2018, with a diagnosis of pancreatic cancer. Clinical history from 0-6 months prior to death was examined for the presence of a palliative care consultation (PCC) encounter. Aggressive interventions of interest, namely emergency department visits, chemotherapy, and ICU admissions, were identified and recorded in both the last six months and the last month of life. Demographic variables such as age, gender, race, and location were also considered during analysis. The PCC group and non-PCC group were compared using the Whitney U-test and Chi-squared test. Results: 2,883 deceased patients with PanCa were identified. However, 2,025 of these patients did not receive PCC in the last six months of life. The average age of death was greater at 70.5 years within the PCC group as compared to 68.9 years within the non-PCC group. This difference was statistically significant. In the last 6 months prior to death, 14.1% of patients overall had chemotherapy. The proportion of patients having chemotherapy was greater among the PCC patients compared to those not (22.4% vs 10.6%). Compared to those who did not receive PCC, patients who had PCC in the end of life were also more likely to be hospitalized (81.1% vs 38.2%), visit emergency departments (45.1% vs 23.7%) and stay in the ICU (14.1% vs 4.0%). In the last 30 days of life, trends were similar. Within PCC, 3.4% had chemotherapy while 1.3% had chemotherapy in the non-PCC group. As far as hospitalizations go, among patients with PCC, 51.3% were hospitalized compared to 15.5% hospitalizations in non-PCC. In patients who had PCC, 14.8% had at least one emergency department visit while 4.8% of patients in the non-PCC group had at least one emergency department visit. Lastly, ICU stays showed a similar trend to the previous interventions. In PCC patients, 7.9% had at least one ICU stay while only 1.5% of patients had one in the non-PCC group. Conclusions: Our study found that less than 30% of patients with PanCa received PCC at the end of life. Findings show an urgency to increase awareness and utilization of PCC for such patients. Interventions should be developed to address this urgency to help improve quality and efficiency of care. Future studies will also identify barriers and facilitators in implementing PC and consultation for patients with PanCa.