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Sun BJ, Tennakoon L, Spain DA, Lee B. Palliative Intervention for Malignant Bowel Obstruction Comes at a Cost: A National Inpatient Study. Am Surg 2024:31348241256083. [PMID: 38782409 DOI: 10.1177/00031348241256083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background: Malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) is associated with poor outcomes. Optimal management for palliation remains unclear. This study aims to characterize nonoperative, procedural, and operative management strategies for MBO and evaluate its association with mortality and cost.Materials and Methods: ICD-10 coding identified patient admissions from the 2018 to 2019 National Inpatient Sample (NIS) for MBO with PC from gastrointestinal or ovarian primary cancers. Management was categorized as nonoperative, procedural, or surgical. Multivariate analysis was used to associate treatment with mortality and cost.Results: 356,316 patient admissions were identified, with a mean age of 63 years. Gender, race, and insurance status were similar among groups. Length of stay (LOS) was longest in the surgical group (surgical: 17 days; procedural: 14 days; nonoperative: 7 days; P = .001). In comparison to nonoperative, procedural and surgical patients had statistically higher hospital charges, post-discharge medical needs, palliative care consults, and admission to rehab centers. Mortality was 7% in nonoperative, 9% in procedural, and 8% in surgical (P = .007) groups. In adjusted analyses, older age, palliative care consult, and non-Medicare payer status were associated with higher mortality. Compared to nonoperative, procedural and surgical groups resulted in increased costs (procedural: $17K more; surgical: $30K more).Conclusions: Admissions for procedural and surgical treatment of MBO are associated with increased LOS, hospital costs, and discharge needs. Optimal management remains challenging. Clinicians must examine all options prior to recommending palliative interventions given a trend towards higher resource utilization and mortality.
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Affiliation(s)
- Beatrice J Sun
- Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lakshika Tennakoon
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - David A Spain
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Byrne Lee
- Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Habib MH, Tiger YKR, Dima D, Schlögl M, McDonald A, Mazzoni S, Khouri J, Williams L, Anwer F, Raza S. Role of Palliative Care in the Supportive Management of AL Amyloidosis-A Review. J Clin Med 2024; 13:1991. [PMID: 38610755 PMCID: PMC11012321 DOI: 10.3390/jcm13071991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Light chain amyloidosis is a plasma-cell disorder with a poor prognosis. It is a progressive condition, causing worsening pain, disability, and life-limiting complications involving multiple organ systems. The medical regimen can be complex, including chemotherapy or immunotherapy for the disease itself, as well as treatment for pain, gastrointestinal and cardiorespiratory symptoms, and various secondary symptoms. Patients and their families must have a realistic awareness of the illness and of the goals and limitations of treatments in making informed decisions about medical therapy, supportive management, and end-of-life planning. Palliative care services can thus improve patients' quality of life and may even reduce overall treatment costs. Light chain (AL) amyloidosis is a clonal plasma cell disorder characterized by the excessive secretion of light chains by an indolent plasma cell clone that gradually accumulates in vital organs as amyloid fibrils and leads to end-organ damage. With progressive disease, most patients develop diverse clinical symptoms and complications that negatively impact quality of life and increase mortality. Complications include cardiac problems including heart failure, hypotension, pleural effusions, renal involvement including nephrotic syndrome with peripheral edema, gastrointestinal symptoms leading to anorexia and cachexia, complex pain syndromes, and mood disorders. The prognosis of patients with advanced AL amyloidosis is dismal. With such a complex presentation, and high morbidity and mortality rates, there is a critical need for the establishment of a palliative care program in clinical management. This paper provides an evidence-based overview of the integration of palliative care in the clinical management of AL amyloidosis as a means of reducing ER visits, rehospitalizations, and in-hospital mortality. We also discuss potential future collaborative directions in various aspects of clinical care related to AL amyloidosis.
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Affiliation(s)
- Muhammad Hamza Habib
- Department of Palliative Care, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, USA
| | - Yun Kyoung Ryu Tiger
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Danai Dima
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Mathias Schlögl
- Department of Geriatric Medicine, Clinic Barmelweid, 5017 Barmelweid, Switzerland;
| | - Alexandra McDonald
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Sandra Mazzoni
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Jack Khouri
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Louis Williams
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Faiz Anwer
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Shahzad Raza
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
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3
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Lu S, Rakovitch E, Hannon B, Zimmermann C, Dharmarajan KV, Yan M, De Almeida JR, Yao CMKL, Gillespie EF, Chino F, Yerramilli D, Goonaratne E, Abdel-Rahman F, Othman H, Mheid S, Tsai CJ. Palliative Care as a Component of High-Value and Cost-Saving Care During Hospitalization for Metastatic Cancer. JCO Oncol Pract 2024:OP2300576. [PMID: 38442311 DOI: 10.1200/op.23.00576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/06/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Abstract
PURPOSE Randomized controlled trials have demonstrated that palliative care (PC) can improve quality of life and survival for outpatients with advanced cancer, but there are limited population-based data on the value of inpatient PC. We assessed PC as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer and identified hospitalization characteristics significantly associated with high costs. METHODS Hospitalizations of patients 18 years and older with a primary diagnosis of metastatic cancer from the National Inpatient Sample from 2010 to 2019 were analyzed. We used multivariable mixed-effects logistic regression to assess medical services, patient demographics, and hospital characteristics associated with higher charges billed to insurance and hospital costs. Generalized linear mixed-effects models were used to determine cost savings associated with provision of PC. RESULTS Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in US dollars (USD) to $56,098 USD, whereas the median hospital cost remained stable at $14,300 USD. Receipt of inpatient PC was associated with significantly lower charges (odds ratio [OR], 0.62 [95% CI, 0.61 to 0.64]; P < .001) and costs (OR, 0.59 [95% CI, 0.58 to 0.61]; P < .001). Factors associated with high charges were receipt of invasive medical ventilation (P < .001) or systemic therapy (P < .001), Hispanic patients (P < .001), young age (18-49 years, P < .001), and for-profit hospitals (P < .001). PC provision was associated with a $1,310 USD (-13.6%, P < .001) reduction in costs per hospitalization compared with no PC, independent of the receipt of invasive care and age. CONCLUSION Inpatient PC is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Integration of inpatient PC may de-escalate costs incurred through low-value inpatient interventions.
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Affiliation(s)
- Sifan Lu
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Eileen Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kavita V Dharmarajan
- Department of Radiation Oncology and the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Yan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - John R De Almeida
- Department of Otolaryngology Head and Neck Surgery, University Health Network, Toronto, ON, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology Head and Neck Surgery, University Health Network, Toronto, ON, Canada
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Fadwa Abdel-Rahman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hiba Othman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sara Mheid
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Chiaojung Jillian Tsai
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Kim S, Chervu N, Premji A, Mallick S, Verma A, Ali K, Benharash P, Donahue T. Association of Inpatient Palliative Care Consultation with Clinical and Financial Outcomes for Pancreatic Cancer. Ann Surg Oncol 2024; 31:1328-1335. [PMID: 37957512 DOI: 10.1245/s10434-023-14528-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Palliative care consultation (PCC) has been shown to improve quality of life and reduce costs for various chronic life-threatening diseases. Despite PCC incorporation into modern pancreatic cancer care guidelines, limited data regarding its specific utilization and impact on resource use is available. METHODS The 2016-2020 Nationwide Readmissions Database was used to identify all adult hospitalizations entailing pancreatic cancer. Only patients with at least one readmission within 90 days were included to account for uncaptured out-of-hospital mortality. Multivariable regression models were used to ascertain the relationship between inpatient PCC during initial hospitalization and index as well as cumulative costs, overall length of stay (LOS), readmission rate, and number of repeat hospitalizations. RESULTS Of an estimated 175,805 patients with pancreatic cancer, 11.1% had inpatient PCC during the index admission. PCC utilization significantly increased from 10.5% in 2016 to 11.6% in 2020 (nptrend < 0.001). After adjustment, PCC was associated with reduced index hospitalization costs [β: - $1100; 95% confidence interval (CI) - 1500, - 800; P < 0.001] and cumulative 90-day costs (β: - $11,700; 95% CI - 12,700, - 10,000; P < 0.001). PCC was associated with longer index LOS (β: + 1.12 days, 95% CI 0.92-1.31, P < 0.001) but significantly reduced cumulative LOS (β: - 3.16 days; 95% CI - 3.67, - 2.65; P < 0.001). Finally, PCC was linked with decreased odds of 30-day nonelective readmission (AOR: 0.48, 95% CI 0.45-0.50, P < 0.001). DISCUSSION PCC was associated with decreased costs, readmission rates, and number of hospitalizations among patients with pancreatic cancer. Directed strategies to increase utilization and reduce barriers to consultation should be implemented to encourage practitioners to maximize inpatient PCC referral rates.
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Affiliation(s)
- Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alykhan Premji
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Timothy Donahue
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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Osagiede O, Nayar K, Raimondo M, Kumbhari V, Lukens FJ. The Determinants of Inpatient Palliative Care Use in Patients With Pancreatic Cancer. Am J Hosp Palliat Care 2023:10499091231218257. [PMID: 37991926 DOI: 10.1177/10499091231218257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Symptom burden management is a major goal of pancreatic cancer care given that most patients are diagnosed late. Early palliative care is recommended in addition to concurrent active treatment; however, disparities exist. We sought to determine the factors associated with inpatient palliative treatment among pancreatic cancer patients and compare treatment outcomes in terms of mortality, discharge disposition and resource utilization. METHODS We conducted a retrospective study of 22,053 pancreatic cancers using the National Inpatient Sample (NIS) database (January - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on palliative treatment. Multivariate regression was used to evaluate patient and hospital characteristics and outcomes associated with palliative treatment. RESULTS A total number of 3839 (17.4%) patients received palliative care. Patients who received palliative care were more likely to be older, Medicaid insured, and nonobese. Patients were less likely to receive palliative care if they are males, Medicare insured, had a lower Charlson comorbidity score, or treated in Urban nonteaching hospitals. Patients who received palliative care displayed higher odds of in-hospital mortality and prolonged LOS. The adjusted additional mean hospital cost and charges in patients who received palliative care were lower by $1459, and $4222 respectively. CONCLUSIONS Inpatient palliative treatment in pancreatic cancer patients is associated with an older age, a higher comorbidity burden, non-obesity, insurance status and urban teaching hospitals. Our study suggests that inpatient palliative treatment decreased hospital resource utilization without prolonging survival.
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Affiliation(s)
- Osayande Osagiede
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kapil Nayar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Yao J, Novosel M, Bellampalli S, Kapo J, Joseph J, Prsic E. Lung Cancer Supportive Care and Symptom Management. Hematol Oncol Clin North Am 2023; 37:609-622. [PMID: 37024385 DOI: 10.1016/j.hoc.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer carries significant mortality and morbidity. In addition to treatment advances, supportive care may provide significant benefit for patients and their caregivers. A multidisciplinary approach is critical in addressing complications of lung cancer, including disease- and treatment-related complications, oncologic emergencies, symptom management and supportive care, and addressing the psychosocial needs of affected patients.
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Affiliation(s)
- Johnathan Yao
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Madison Novosel
- Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Shreya Bellampalli
- Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jennifer Kapo
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208025, New Haven, CT 06520, USA
| | - Julia Joseph
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Elizabeth Prsic
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208028, New Haven, CT 06520, USA.
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Nursey F, Gillett K. Intrathecal drug delivery for cancer pain at the end of life: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S16-S22. [PMID: 36913330 DOI: 10.12968/bjon.2023.32.5.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Two-thirds of patients with advanced cancer have pain and, of these, approximately 10-20% do not respond to conventional pain management approaches. This case study concerns a hospice patient who received intrathecal drug delivery for intractable cancer pain at the end of life. This involved working in partnership with a hospital-based interventional pain team. Despite side-effects and complications associated with intrathecal drug delivery and the requirement for inpatient nursing care, intrathecal drug delivery was the best option for the patient. The case identifies the importance of a patient-centred approach to decision-making, effective partnerships between hospice and acute hospital teams, and nurse education as key factors contributing to the provision of safe and effective intrathecal drug delivery.
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Monnery D, Liu Y, Griffiths A, Lockhart J, Coyle S, Olsson-Brown A. Multidisciplinary supportive care in cancer: cost analysis. BMJ Support Palliat Care 2022:spcare-2022-004135. [PMID: 36581451 DOI: 10.1136/spcare-2022-004135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Enhanced supportive care (ESC) is the early implementation of supportive care in cancer. In England, this model is being developed to support patients with treatable but not curable cancer and implements a multiprofessional approach. OBJECTIVE To describe the workforce and cost-effectiveness of an outpatient ESC service in a tertiary cancer centre in England. METHODS Workforce costs to deliver ESC to 265 patients was collected. Service impact on secondary care usage in the last year of life was compared against the regional and national average derived from the National Health Service Digital Secondary Uses Service dataset. RESULTS Our ESC service required the input of seven professional groups and cost £125 542 for 12 months. ESC patients had an average of 1.72 fewer admissions per patient per last year of life than the national average. Length of stay was reduced from an average of 9.2 days to 4.78 days per admission in the last year of life. The reduced secondary care usage saved £2 398 537.68. CONCLUSIONS Outpatient ESC in this cohort required an multidisciplinary team approach and saved money through secondary care use reduction.
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Affiliation(s)
- Daniel Monnery
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | | | - Ann Griffiths
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Jill Lockhart
- NHS England Specialised Commissioning Improving Value Team, London, UK
| | - Seamus Coyle
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
| | - Anna Olsson-Brown
- Department of Clinical and Molecular Pharmacology, University of Liverpool, University of Liverpool, Liverpool, UK
- Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
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Abian MH, Antón Rodríguez C, Noguera A. End of Life Cost Savings in the Palliative Care Unit Compared to Other Services. J Pain Symptom Manage 2022; 64:495-503. [PMID: 35842179 DOI: 10.1016/j.jpainsymman.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Hospital deaths carry a significant healthcare cost that has been confirmed to be lower when palliative care units (PCUs) are available. OBJECTIVES To compare the last admission hospital health care cost of dying in a first-level hospital between the PCU and the rest of the hospital services. METHODS A retrospective, comparative, observational study evaluating costs from the payer perspective on treatments and diagnostic-therapeutic tests performed on patients who die in first-level hospital, comparing whether they were treated by the PCU or another unit (Non-PCU). Patients with a mortality risk >2 were included according to the Severity of Illness Index (SOI) and Risk of Mortality (MOR). All cost express in €, median per patient and interquartile range (IQR). RESULTS From 1,833 patients who died, 1,389 were included, 442 (31.1%) treated by PCU and 928 (68.9%) Non-PCU. Statistical differences were found for the last admission total cost (€262.8 (€470.1) for PCU versus €515.3 (€980.48) in Non-PCU), daily total cost (€74.27 (€127.4) vs €115.8 (€142.4) Non-PCU). Savings were maintained when the sample was broken down by diagnosis-related group (DRG) and a multivariate analysis was performed to determine how the different patients baseline characteristics between PCU and Non-PCU patients influenced the results obtained. CONCLUSIONS Data from this study show that cost is significantly lower when the patients are treated by a PCU during their last hospital stay when they pass away.
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Affiliation(s)
- María Herrera Abian
- Palliative Care Chief, Hospital Universitario Infanta Elena (M.H.A.), Valdemoro, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (M.H.A.), Madrid, España
| | - Cristina Antón Rodríguez
- Palliative Care Chief, Hospital Universitario Fundación Jiménez Díaz (C.A.R., A.N.), Madrid, España; Unidad de Apoyo a la Investigación, Facultad de Medicina (C.A.R.), Universidad Francisco de Vitoria, Madrid, España.
| | - Antonio Noguera
- Palliative Care Chief, Hospital Universitario Fundación Jiménez Díaz (C.A.R., A.N.), Madrid, España
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Chang J, Han KT, Medina M, Kim SJ. Palliative care and healthcare utilization among deceased metastatic lung cancer patients in U.S. hospitals. BMC Palliat Care 2022; 21:136. [PMID: 35897031 PMCID: PMC9327255 DOI: 10.1186/s12904-022-01026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The benefits of palliative care for cancer patients were well developed; however, the characteristics of receiving palliative care and the utilization patterns among lung cancer patients have not been explored using a large-scale representative population-based sample. Methods The National Inpatient Sample of the United States was used to identify deceased metastatic lung cancer patients (n = 5,068, weighted n = 25,121) from 2010 to 2014. We examined the characteristics of receiving palliative care use and the association between palliative care and healthcare utilization, measured by discounted hospital charges and LOS (length of stay). The multivariate survey logistic regression model (to identify predictors for receipts of palliative care) and the survey linear regression model (to measure how palliative care is associated with healthcare utilization) were used. Results Among 25,121 patients, 50.1% had palliative care during the study period. Survey logistic results showed that patients with higher household income were more likely to receive palliative care than those in lower-income groups. In addition, during hospitalization, receiving palliative care was associated with11.2% lower LOS and 28.4% lower discounted total charges than the non-receiving group. Conclusion Clinical evidence demonstrates the benefits of palliative care as it is associated with efficient end-of-life healthcare utilization. Health policymakers must become aware of the characteristics of receiving the care and the importance of limited healthcare resource allocation as palliative care continues to grow in cancer treatment.
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Affiliation(s)
- Jongwha Chang
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA
| | - Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Center, Goyang, Republic of Korea.,National Hospice Center, National Cancer Center, Goyang, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Sun Jung Kim
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA. .,Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea. .,Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea. .,Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea.
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