Odds Of Palliative Care Research Articles

Survey of palliative care use in primary malignant bone tumors: An NCDB review.

e23514 Background: Palliative care has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Methods: This study retrospectively evaluated the use of palliative care in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 coding and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different patient and tumor characteristics. Multivariable logistic binary logistic regression was performed to evaluate relationships between patient and tumor characteristics and the use of palliative care. Results: 24,401 patients with primary malignant bone tumors were identified. Overall, only 2.52% had any form of palliative care utilization. Of those receiving palliative care, 55.5-65.1% were treated with only non-curative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of palliative care were decreased for patients with chordomas, patients living more than 24 miles from the treatment facility, patients living in west-south-central or pacific states, or patients with private insurance, medicare, or unknown insurance status. Odds of palliative care were increased in patients with greater tumor diameter or unknown tumor size, tumors in the midline, increased tumor grade, stage 4 tumors, or patients living in urban areas. Conclusions: Palliative care use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, midline tumors, or in patients living in urban areas, but overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of palliative care.

Do advance directives predict receipt of palliative care? An evaluation of a single-institution in the Veterans Administration health care system.

203 Background: Cancer-related deaths are often preceded by high utilization of non-beneficial care that may contribute to poor quality of life, adverse symptoms, and high costs. Over the past several years, there is increased attention on palliative care to limit these challenges. Yet, rates of palliative care referral at the end of life remain low, and there are few studies that evaluate why. Our objective is to study whether one potentially important factor among patients with advanced cancer, advance directives, influence referral to palliative care among patients with advanced cancer. Methods: We conducted a retrospective chart review of all patients diagnosed with Stage III and IV cancers and treated at the Veterans Administration Palo Alto Healthcare System (VAPAHCS) in Fiscal Year 2012-2013. Chi-squared tests estimated differences in receipt of palliative care by individual- and clinical-factors. Logistic regression models estimated odds of receipt of palliative care after adjustment for individual and clinical factors). Results: There were 276 patients diagnosed with Stage III and IV cancer during the years of study. No records were excluded from analysis. Median age at diagnosis was 68; thoracic cancers were the most common (31%, p = 0.001). A minority of patients (45%) received palliative care or hospice. Rates of referral to palliative care and hospice were highest among patients with stage IV disease (p=0.003). In logistic regression models adjusted for individual and clinical factors only stage of disease predicted increased odds of palliative care and hospice referral. We could not reject the null hypothesis that presence of an advance directive increased palliative care or hospice treatment. Conclusions: Advance directives may be a useful tool to help patients transition to palliative care and hospice, however, we found no influence of advance directives on the receipt of these services in our VA facility. Future studies should evaluate other factors that predict receipt of high quality end-of-life care for patients with cancer.