Impact of Inpatient Palliative Care Consultation on Health Care Utilization and Expenditures Among Patients with Gastrointestinal Cancer

Abstract

Background and Objective:

Palliative care (PC) has demonstrated the ability to improve patient outcomes and quality of life among patients with life-threatening diseases. The current study aimed to investigate the impact of inpatient PC on health care utilization and expenditure among patients with advanced gastrointestinal (GI) cancer.

Methods:

Patients diagnosed with advanced GI cancer (2007–2019) were identified from the SEER-Medicare database in the United States. Multivariable regression with entropy balancing was used to analyze the association between inpatient PC and outcomes, including readmission, length of stay (LOS), and expenditure.

Results:

Among 48,100 patients diagnosed with advanced GI cancer (colon: n = 23,080, 48.0%; pancreas: n = 12,280, 25.5%; rectum: n = 6497, 13.5%; biliary: n = 3551, 7.3%; liver: n = 2692, 5.6%), 1277 (2.65%) received PC. Median patient age was 77 (72–83) with most being female (n = 25,687, 53.4%). Patients with PC were more likely to be discharged to skilled nursing facility (SNF) (42.3% vs. 17.9%) and less likely to get readmitted within 30 days (18.2% vs. 28.1%). On adjusted analysis, patients with PC had higher costs at index admission (mean difference [β]: $1,494, 95% confidence interval [CI] $1,394–$1,594) but lower 90-day expenditure (β: −$3,037, 95% CI: −$3,279 to −$2,796). PC was also linked with lower odds of readmission (odds ratio 0.39, 95% CI: 0.33–0.46) and cumulative 90-day LOS (β: −1.31, 95% CI: −1.62 to −0.99).

Conclusion:

Following inpatient PC, patients with advanced GI cancer experienced fewer readmissions, days in hospital, and lower costs. Integrating PC into cancer care is vital to enhance patient outcomes while alleviating the strain on health care resources.