Cost of care, discharge disposition, and survival of advanced cancer patients (ACP) receiving early inpatient palliative care (PC) compared to standard oncologic care (SOC) without palliative care.

Authors

null

Christopher Daugherty

University of Chicago, Chicago, IL

Christopher Daugherty, Julie Johnson, Stacie K. Levine, Kristen Wroblewski, Bradford Lane, William Dale, Monica Malec, Fay J. Hlubocky

Organizations

University of Chicago, Chicago, IL, University of Chicago Medicine, Chicago, IL, CIY, Chicago, IL, University of Chicago Pritzker School of Medicine, Chicago, IL

Research Funding

Other

Background: PC significantly enhances ACP quality of life, provides symptom control, improves transitions to end-of-life care, and mortality. However, the financial implications, discharge disposition, and survival benefits of early, inpatient PC compared to SOC remains less understood. Methods: Retrospective cohort analysis of ACP receiving either PC or SOC between Jan 2015-Dec 2015 (N=810). ACP cohorts were compared for demographics, costs, disposition, and survival. Financial costs collected included: fixed (overhead expenditures, facility maintenance, hospital property); variable (patient care supplies, diagnostic/therapeutic supplies, medications); operating (fixed, variable, breaking-even costs); direct (labor, materials, commissions, piece-rate wages, manufacturing supplies); indirect (production supervision salaries, quality control, insurance, depreciation). Univariate and multivariate analyses were completed. Results: 468 were admitted to PC and 342 to SOC. In comparison with SOC, PC were more likely to be: younger (61.1±13.2 vs. 62.5±13.0, p=0.02); African American (48% vs. 36%, p=0.0045); female (50% vs. 40%, p=0.005); and have shorter length of inpatient stay (5.7± 4.9 vs. 6.2±6.5, p=0.01). PC had significantly lower costs: direct ($9,478 vs. $10,416, p=0.01); indirect ($9,538 vs. $10,999, p=0.002); fixed ($10,308 vs. $12,076, p=0.001); variable ($8,709 vs. $ 9,339, p=0.02); operating ($19,017 vs. $21,416, p=0.003).Compared with SOC, ACP receiving PC were more likely to be discharged to: home (55% vs.45%, p=0.01); health care facilities (e.g. skilled nursing, inpatient rehabilitation) (36.1% vs. 20%, p=0.04); and hospice (home and inpatient) (7.7% vs. 5.8%, p=0.02). PC had overall greater median survival from the time of discharge (106.8±99.95 vs. 73.8±61.93, p=0.03) compared to SOC. Conclusions: Early PC results in less financial burden and greater cost savings for inpatient ACP including for those who are younger and underserved. These findings provide further evidence for policies arguing that ACP access to routine PC must become a health care priority.

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Abstract Details

Meeting

2018 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A: Communication and Shared Decision Making; Integration and Delivery of Palliative and Supportive Care; and Psychosocial and Spiritual/Cultural Assessment and Management

Track

Integration and Delivery of Palliative and Supportive Care,Communication and Shared Decision Making,Psychosocial and Spiritual/Cultural Assessment and Management

Sub Track

Integration and Delivery of Palliative and Supportive Care

Citation

J Clin Oncol 36, 2018 (suppl 34; abstr 130)

DOI

10.1200/JCO.2018.36.34_suppl.130

Abstract #

130

Poster Bd #

F2

Abstract Disclosures