The utilization of inpatient palliative care services (PCS) in patients with metastatic cancer receiving critical care therapies (CCTs).

Abstract

103 Background: PCS have been shown to improve symptom management, quality of life and survival in patients with metastatic cancer as well as reduce healthcare costs. We aimed to investigate the utilization pattern of inpatient PCS and outcomes in metastatic cancer patients across the various cancer subtypes who received CCTs. Methods: We used the 2010 California Healthcare Cost and Utilization Project - State Inpatient Database to identify patients (≥18 years) and above with metastatic cancer who received CCTs, defined as the use of invasive mechanical ventilation, acute dialysis, total parenteral nutrition, percutaneous endoscopic gastrostomy or tracheostomy. We examined the use of inpatient PCS and outcomes including inpatient mortality, length of stay, discharge to skilled nursing facility, cost of care and presence of do-not-resuscitate. Results: A total of 9,348 hospitalizations were identified. The cancer subtypes were lung (14%), breast (5%), colorectal (13%), genitourinary (8%) and others (37%). Overall, 19% had documented involvement of inpatient PCS. Patients with lung cancer had the highest utilization of inpatient PCS (25%), compared to breast (20%), genitourinary (17%) and colorectal (13%) cancers. Other outcomes are shown in Table. Conclusions: Inpatient PCS were underutilized in patients with metastatic cancer who were critically ill. Future studies should look into the benefits of early integration of inpatient PCS in this population who are at high-risk of mortality. [Table: see text]