Abstract
Background—Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives—To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical characteristics, hospital charges, and LOS. Methods—De-identified patient data of each hospitalization were retrieved from the National Inpatient Sample (NIS) database. Codes V66.7 (ICD-9-CM) or Z51.5 (ICD-10-CM) were used to find palliative care utilization. Multivariate adjusted logistic regression analyses were conducted to assess factors associated with palliative care use, LOS, hospital charges, and in-hospital death. Results—Of 4426 hospitalizations, only 6.7% received palliative care services. Palliative care utilization did not significantly increase over time (p = 0.06); it reduced hospital charges by USD 25,937 (p < 0.0001) and LOS by 1.3 days (p = 0.0004) per hospitalization. Palliative care was positively associated with female gender, severe disease, and age group ≥80 (p ≤ 0.05). The average LOS was 8.5 days for each admission. Conclusions—Hospital admissions with palliative care utilization had lower hospital charges and LOS in ECC. However, ECC patients received less palliative care compared with more common cancers sharing similar symptoms (e.g., pancreatic cancer). ECC patients also had longer LOS compared with the national average. Further research is warranted to develop interventions to increase palliative care utilization among ECC hospital patients.
Highlights
Some intensive interventions for end-stage cancer patients do not produce better outcomes and merely exacerbate the financial burden [1,2]. These charges, as well as significant discomfort, could potentially be avoided by engagement with palliative care [1,2], whereby an expert interdisciplinary team consisting of physicians, nurses, social workers, and other specialties work together to alleviate pain as well as psychological and spiritual distress of patients struggling with terminal diseases [3,4]
In the current study, using V66.7 (ICD-9, before October 2015) and Z51.5 (ICD-10, after October 2015) codes within the National Inpatient Sample (NIS) database, we aimed to characterize the extent of utilization of inpatient palliative care services among ECC patients and the influence of several factors on this usage, including gender, age, race/ethnicity, in-hospital death, length of stay (LOS), hospital charges, payer source, and severity of the disease
Differences in palliative care utilization by tumor type have been documented in prior studies [10], efforts should be made to increase palliative care utilization among ECC patients to at least the level used in pancreatic cancer, a malignancy most similar in presentation, symptoms, and prognosis
Summary
Cancer patients and their families, especially those coping with end-stage disease, often simultaneously face a poor quality of life and a considerable financial burden from hospital charges. Some intensive interventions for end-stage cancer patients do not produce better outcomes and merely exacerbate the financial burden [1,2]. These charges, as well as significant discomfort, could potentially be avoided by engagement with palliative care [1,2], whereby an expert interdisciplinary team consisting of physicians, nurses, social workers, and other specialties work together to alleviate pain as well as psychological and spiritual distress of patients struggling with terminal diseases [3,4].
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