Early Palliative Care for Patients With Brain Metastases Decreases Inpatient Admissions and Need for Imaging Studies

Habibi, Akram; Wu, Shengyang; Gorovets, Daniel; Sansosti, Alexandra A.; Kryger, M.; Beaudreault, Cameron; Chung, Wei-Yi; Shelton, Gary; Silverman, Joshua; Lowy, Joseph; Kondziolka, Douglas

doi:10.1177/1049909118765405

Cited by 16 publications

(11 citation statements)

References 34 publications

(44 reference statements)

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“…Our study builds on earlier work evaluating the impact of PC interventions and health care utilization. 13,22,23 Jang et al 22 performed a retrospective population-based cohort study using administrative data in patients with pancreatic cancer. In this study, PC encounters were associated with less aggressive care towards the end of life, including chemotherapy, ICU admissions, multiple ED visits, and hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer

Bevins¹,

Bhulani

Goksu

et al. 2021

American Journal of Clinical Oncology

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Objectives: Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients.Materials and Methods: We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined "early PC" if the patients received PC within 30 days of diagnosis.Results: A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P < 0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P = 0.004) and lower total charges of ED care ($3158 vs. $3981, P < 0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P = 0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P = 0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P = 0.007) and lower charges of ED care (P = 0.018) for all patients.Conclusions: Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer

Bevins¹,

Bhulani

Goksu

et al. 2021

American Journal of Clinical Oncology

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“…Palliative care interventions are most effective when implemented far from the time of death. 2,6 Daly et al (2013) demonstrated that patients with a greater survival expectancy had larger gains in the quality of life indicators with the addition of a coordinated support team than did patients with a shorter life expectancy. 5 When palliative care is initiated within the last days or weeks of life, it has not been shown to have as great an impact, likely because much of the effective interventions rely on eliciting goals of care, illness understanding, and helping patients and the families prepare for end of life.…”

Section: Discussionmentioning

confidence: 99%

“…healthcare that focuses on optimal management of pain and other symptoms while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs and cultures.'' 1 This philosophy has been implemented in a variety of ways in oncology practices around the world [2][3][4][5][6][7][8][9][10][11][12][13][14] and has been shown to improve patient outcomes, including decreased symptom severity, improved quality of life, and in some cases, decreased utilization of emergency department (ED) and hospital admissions. [15][16][17] The study by Temel et al (2010) showed improvement in quality of life, and notably increased survival in patients with advanced lung cancer when palliative care was introduced early in the course of illness.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study

et al. 2019

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Context: Palliative care in oncology provides multiple benefits, however access to specialty palliative clinicians is limited in community cancer centers. Individual support services are more often available, but little is known on the utilization and impact of these services. Objectives: To describe the utilization of outpatient support services in the advanced cancer population and the association with ED and hospital use in a community setting. Methods: A retrospective chart review of 314 patients with advanced cancer of lung, gastrointestinal, genitourinary, and gynecologic origin was conducted. Data collected included demographics, descriptive data, type and number of support services (symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor) within 90 days of diagnosis and descriptions of ED visits/hospitalizations within 12 months of diagnosis. Support services were available to patients by referral. Results: 29.6% of patients were deceased within 6 months and were considered to have severe disease. Patients with severe disease had a significantly greater mean number of support services than patients with non-severe disease (8.9 vs 6.0, p=0.001) and had a greater mean number of visits per year to the ED (6.4 vs 1.8, p<0.001). A greater proportion of patients with severe disease had palliative consultations (48.9% vs 21.7%, p<0.001), but 65.5% of palliative consultations occurred after an ED or hospital visit. Conclusion: Our data demonstrated that advanced cancer patients with severe disease had increased healthcare utilization in all areas measured. Despite high utilization, outpatient support services used in a reactive manner were not effective in reducing ED or hospital visits.

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“…Brain metastases are the most common intracranial tumors affecting 8–10% of cancer patients; the majority experience 1–3 brain lesions with poor prognosis in terms of overall survival, progression-free survival and neurological function 1 – 4 . Uncontrolled brain metastases often result in headaches, neurocognitive dysfunction, seizures, and eventually death 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Although brain metastases are the main cause of morbidity and mortality among cancer patients, younger age, higher Karnofsky Performance Score (KPS), fewer brain lesions, and uncontrolled extracranial disease were associated with improved prognosis 5 . The life expectancy of patients having brain metastases is approximately 12 months if they receive recommended radiation and/or surgical therapies or less than 12 months if they only receive supportive care 1 , 7 . Whereas neurologic manifestations affect 70% of patients with brain metastases potentially reducing their quality of life, recommended treatments (whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and/or surgical resection) may incur considerable costs on the healthcare system with varying impact on neurological function 1 , 7 .…”

Section: Introductionmentioning

confidence: 99%

Hospitalization outcomes among brain metastasis patients receiving radiation therapy with or without stereotactic radiosurgery from the 2005–2014 Nationwide Inpatient Sample

Beydoun

Huang

et al. 2021

Sci Rep

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The purpose of this study was to compare hospitalization outcomes among US inpatients with brain metastases who received stereotactic radiosurgery (SRS) and/or non-SRS radiation therapies without neurosurgical intervention. A cross-sectional study was conducted whereby existing data on 35,199 hospitalization records (non-SRS alone: 32,981; SRS alone: 1035; SRS + non-SRS: 1183) from 2005 to 2014 Nationwide Inpatient Sample were analyzed. Targeted maximum likelihood estimation and Super Learner algorithms were applied to estimate average treatment effects (ATE), marginal odds ratios (MOR) and causal risk ratio (CRR) for three distinct types of radiation therapy in relation to hospitalization outcomes, including length of stay (‘ ≥ 7 days’ vs. ‘ < 7 days’) and discharge destination (‘non-routine’ vs. ‘routine’), controlling for patient and hospital characteristics. Recipients of SRS alone (ATE = − 0.071, CRR = 0.88, MOR = 0.75) or SRS + non-SRS (ATE = − 0.17, CRR = 0.70, MOR = 0.50) had shorter hospitalizations as compared to recipients of non-SRS alone. Recipients of SRS alone (ATE = − 0.13, CRR = 0.78, MOR = 0.59) or SRS + non-SRS (ATE = − 0.17, CRR = 0.72, MOR = 0.51) had reduced risks of non-routine discharge as compared to recipients of non-SRS alone. Similar analyses suggested recipients of SRS alone had shorter hospitalizations and similar risk of non-routine discharge when compared to recipients of SRS + non-SRS radiation therapies. SRS alone or in combination with non-SRS therapies may reduce the risks of prolonged hospitalization and non-routine discharge among hospitalized US patients with brain metastases who underwent radiation therapy without neurosurgical intervention.

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Early Palliative Care for Patients With Brain Metastases Decreases Inpatient Admissions and Need for Imaging Studies

Abstract: Timely PC consultations are advisable in this patient population and can reduce health-care utilization.

Cited by 16 publications

References 34 publications

Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer

Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer

Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study

Hospitalization outcomes among brain metastasis patients receiving radiation therapy with or without stereotactic radiosurgery from the 2005–2014 Nationwide Inpatient Sample

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