End-of-life outcomes of advanced cancer patients enrolled in palliative care

Abstract

PURPOSE: We sought to understand how Palliative Care (PC) enrollment differs between patient demographics and whether enrollment affects end of life (EOL) outcomes in an integrated system. METHODS: This retrospective cohort study included Stage IV solid cancer patients who died within 1 year of diagnosis within Kaiser Permanente Northern California between 1/1/2018-12/31/2020. Demographics and EOL outcomes were compared by PC enrollment. Categorical and continuous comparisons were made using Pearson’s χ2 and Wilcoxon Rank Sum tests. Logistic regression was performed to assess independent predictors of EOL outcomes. RESULTS: Among 3,575 patients, 45.1% enrolled in PC. Age and comorbidities (p < 0.01) differed between groups; race (p = 0.32) and socioeconomic status (p = 0.54) did not. PC was associated with lower odds of hospitalization (OR 0.62, CI 0.54–0.72) and ICU admission (OR 0.30, CI 0.32–0.50) in the last 30 days of life (DOL) and higher odds of hospice enrollment (OR 2.12, CI 1.81–2.41). More PC visits correlated with more hospice enrollment (49.2% 4 + PC visits, 43.6% 2–3 visits, and 39.9% 1 visit, p = 0.01) and less hospitalization in the last 30 DOL (33.5% vs. 34.4% vs. 45.4%, p < 0.01). Patients in PC had shorter hospital stays (4.0 days vs. 5.0 days, p < 0.01). CONCLUSION: There was improvement in EOL outcomes for patients in PC in their last year of life, with greater improvements as PC visits increased. No racial/ethnic or socioeconomic disparities were observed in enrollment.