Cancer mortality rates have been declining over the past 2 decades, and the observed improvements in survival are partially attributable to advances in treatment options.1,2 Treatment-associated complications and disease progression have led to an increase in emergency department visits, hospitalizations, and intensive care unit (ICU) admissions during the course of treatment.3 Critical care therapies (CCTs), such as invasive mechanical ventilation (IMV), can be lifesaving; however, the inherent risks (eg, infections, need for hospitalizations) are higher in patients with advanced cancer given its incurable nature and the frequent need for prolonged treatment.4,5
A prior systematic review showed that the integration of palliative care interventions in the care of patients with life-limiting illnesses in the outpatient, acute care, and ICU settings can reduce ICU admissions and length of stay (LOS).6 In addition, palliative care services have been shown to improve symptom management, quality of life, and survival in some patients with metastatic cancer, and may also help reduce healthcare costs.7–9 However, the use pattern of inpatient palliative care (IPC) services for patients with advanced cancer receiving CCTs has not been well characterized. In patients with metastatic head and neck cancer, use of IPC services was reported to be 5%.10 In another study, IPC services were used in 17% of patients admitted to the oncology service.11 Overall, these rates were low considering the poor prognoses of patients with advanced cancer admitted to the hospital.
In this study of hospitalized patients with metastatic cancer who received CCTs, we investigated IPC use and described outcomes (including in-hospital mortality, LOS, discharge destination, and cost of care) of patients who received IPC services and those who did not, and considered predictors of IPC use. Results were assessed based on IPC use to illustrate the poor outcomes associated with this population. We also looked at the use pattern of IPC services across the 4 most common cancer subtypes in our population (lung, breast, colorectal, and genitourinary). We hypothesized that use of IPC services was low in this cohort of patients.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
Dr. Lagu is supported by the National Heart, Lung, and Blood Institute of the NIH (K01HL114745). Dr. Lagu has received consulting fees from the Institute for Healthcare Improvement, under contract to CMS, for her work on a project to help health systems achieve disability competence. Dr. Stefan is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (1 K01HL11463101A1). Dr. Lindenauer was supported by a grant from the National Heart, Lung, and Blood Institute (K24HL132008).
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