Palliative care utilization and mortality in patients who received inpatient chemotherapy.

Authors

null

Justine Anderson

Icahn School of Medicine at Mount Sinai, New York, NY

Justine Anderson, Shivani Handa, Giulia Petrone, Nobel Chowdhury, Deukwoo Kwon, Aarti Sonia Bhardwaj, Priya Jain, Cardinale B. Smith, Natalie S Berger

Organizations

Icahn School of Medicine at Mount Sinai, New York, NY, Icahn School of Medicine at Mount Sinai, Division of Hematology and Medical Oncology, New York, NY, Icahn School of Medicine/Mount Sinai Morningside-West Hospital, New York, NY

Research Funding

No funding received
None.

Background: Early integration of palliative care (PC) into advanced cancer care has been shown to improve quality of life and prognostic understanding. However, there is a paucity of data on utilization of inpatient PC consultation and survival outcomes in patients (pts) receiving inpatient chemotherapy (IC). Methods: A retrospective review was performed at a single academic center of pts receiving IC between Jan 2016 and Dec 2017. We evaluated utilization of PC services, reasons for consult, code status, disposition, and 60-day mortality. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect, taking into account correlations from multiple admissions per patient. Cumulative incidence plot and Cox proportional hazard regression models were used to assess the association between mortality and study covariates. Results: Of 880 admissions, 733 (83%) were hematologic malignancies (HM) and 147 (17%) were solid tumors (ST). PC consults were more likely in ST than HM (OR 3.19, 95% CI 1.85 - 5.50) and for KPS ≤50% (OR 22.20, 95% CI 11.51- 42.79). Of 159 PC consults, 91 (57%) were for pain and 25 (16%) for goals of care. 66 pts (10%) who received IC died within 60 days of admission, 44 (67%) HM and 22 (33%) ST (p = 0.002). In pts who died within 60 days, 63% had PC consult. Median time from admission to PC consult was 2 days for ST and 9 for HM. Of those with PC consult, 40% had a change from full code to DNR/DNI and were more likely to have a health care proxy (HCP) assigned (OR 7.31, p = 0.001). PC consults were also associated with significantly higher odds of discharge to hospice (OR 10.52, 95% CI: 4.3-25.6; p = < 0.0001; Table). Mortality risk was higher in those admitted for symptoms/complications related to their disease or with progression (HR 3.24, 95% CI (2.50-4.19), p < 0.001) and in those with advanced stage disease: Stage 3 (p = 0.033); Stage 4 (p = 0.0003). Of the pts who died within 60 days, 33 (50%) died during the admission and 24 (36%) in hospice. Conclusions: Significant 60-day mortality after receiving IC is consistent with aggressive end-of- life care. Pts with ST and those with poor performance status more frequently utilized inpatient PC services; however, there is opportunity to increase utilization amongst pts with HM and introduce PC earlier in the inpatient clinical course. PC consultations improve advanced care planning with appropriate transitions in code status, HCP assignments and discharge to hospice.

Disposition of pts with and without PC consult.

Disposition
PC
No Consult

N = 684 (%)
Consult

N = 159 (%)
Home
645 (94)
116 (73)
Rehabilitation/Skilled Nursing Facility
32 (5)
17 (11)
Hospice
7 (1)
18 (11)
Unknown
-
8 (5)

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Palliative Care

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 198)

DOI

10.1200/JCO.2022.40.28_suppl.198

Abstract #

198

Poster Bd #

A23

Abstract Disclosures

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