Objective Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. Methods A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher's Exact, Mann–Whitney U, Kaplan–Meier, and Student's T testing. Results 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720), p = 0.01. Conclusions Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.

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Objective There is limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in last six months of life. Patient demographics, patterns of care and utilization of palliative medicine consultation services were evaluated. Methods 100 patients who died from gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within one year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record and analyses were made using Students T, and Mann-Whitney testing with SPSS software. Results The mean age of patients was 60 years (range 30–94 years). Racial/ethnic distribution was 38% Caucasian, 34% Black, and 15% Hispanic. 75% of patients received chemotherapy within the last six months of life, 30% received chemotherapy within the last six weeks of life. The median number of days hospitalized during the last six months of life was 24 (range 0–183 days). During the last six months of life, 19% were admitted to the Intensive Care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardio-pulmonary resuscitative efforts. 64% had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had ≥ 14 days from consultation until death versus patients who had ≤ 14 days or no consultation, 21 (72%) versus 29 (41%), p =0.004. Patients who were single were less likely to have a palliative medicine consultation, p=0.005. Conclusions End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality-of-life. These pilot data suggest that factors for implementation of timely hospice referral, family support and legacy building should include specialists trained in palliative medicine.