Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective

Abstract

Background—Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives—To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical characteristics, hospital charges, and LOS. Methods—De-identified patient data of each hospitalization were retrieved from the National Inpatient Sample (NIS) database. Codes V66.7 (ICD-9-CM) or Z51.5 (ICD-10-CM) were used to find palliative care utilization. Multivariate adjusted logistic regression analyses were conducted to assess factors associated with palliative care use, LOS, hospital charges, and in-hospital death. Results—Of 4426 hospitalizations, only 6.7% received palliative care services. Palliative care utilization did not significantly increase over time (p = 0.06); it reduced hospital charges by USD 25,937 (p < 0.0001) and LOS by 1.3 days (p = 0.0004) per hospitalization. Palliative care was positively associated with female gender, severe disease, and age group ≥80 (p ≤ 0.05). The average LOS was 8.5 days for each admission. Conclusions—Hospital admissions with palliative care utilization had lower hospital charges and LOS in ECC. However, ECC patients received less palliative care compared with more common cancers sharing similar symptoms (e.g., pancreatic cancer). ECC patients also had longer LOS compared with the national average. Further research is warranted to develop interventions to increase palliative care utilization among ECC hospital patients.

Inpatient palliative care utilisation among patients with gallbladder cancer in the United States: A 10‐year perspective

“…Observed wide differences may partly reflect differences in the study periods since palliative care utilisation has been increasing in recent years (Liu et al, 2019). Increases likely result from several factors, including the growth in the number of hospitals providing palliative care services, the implementation of the Patient Protection and Affordable Care Act (ACA), and the accumulating evidence of palliative care benefits (2019; Liu et al, 2019), such as a reduction in hospital charges (Kelley & Morrison, 2015; Liu et al, 2019; Mojtahedi et al, 2021; Mulvey et al, 2016). Of note, our study found palliative care utilisation sizably reduced hospital charges during a given admission by an average of $12,405.…”

“…Although palliative care is ideally provided throughout serious illnesses alongside curative therapies, most patients referred to inpatient palliative care services have been shown to be at the end of life (Liu et al, 2019; Mojtahedi et al, 2021). We found that palliative care utilisation was much higher during hospitalizations ending in death compared to those with alive discharge.…”

“…However, the large number of our cases seem to have minimised this possible error since our data is in line with current literature. For example, the association of palliative care with older ages and disease severity has been frequently shown in cancer (Liu et al, 2019; Mojtahedi et al, 2021).…”

Home Palliative Care during the COVID-19 Pandemic: A Scoping Review

“…The palliative care team is multidisciplinary and consists of physicians, nurses, social workers, and other specialists to cover a range of conditions from pain to emotional/ financial challenges of patients, their families, or caregivers. 1,3 In addition, the palliative care team discusses with patients advance care planning, a process that enables patients to express their values and preferences for future care. 4 Palliative care can be offered in different settings, such as hospitals, hospice facilities, out-patient clinics, nursing homes, and home.…”