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.
ArnoldM, AbnetCC, NealeRE, et al.Global burden of 5 major types of gastrointestinal cancer. Gastroenterology, 2020; 159(1):335–349.e15; doi: 10.1053/j.gastro.2020.02.068
2.
MeeT, KirkbyNF, DefournyNN, et al.The use of radiotherapy, surgery and chemotherapy in the curative treatment of cancer: Results from the FORTY (Favourable Outcomes from RadioTherapY) project. Br J Radiol, 2023; 96(1152):20230334; doi: 10.1259/bjr.20230334
3.
ZeineddineFA, ZeineddineMA, YousefA, et al.Survival improvement for patients with metastatic colorectal cancer over twenty years. NPJ Precis Oncol, 2023; 7(1):16; doi: 10.1038/s41698-023-00353-4
4.
ShakeelS, FinleyC, Akhtar-DaneshG, et al.Trends in survival based on treatment modality in patients with pancreatic cancer: A population-based study. Curr Oncol, 2020; 27(1):e1–e8; doi: 10.3747/co.27.5211
5.
NakamuraY, HirookaM, HiraokaA, et al.Survival improvements in advanced hepatocellular carcinoma with sequential therapy by era. Cancers (Basel), 2023; 15(21):5298; doi: 10.3390/cancers15215298
6.
RobatelS, SchenkM. Current limitations and novel perspectives in pancreatic cancer treatment. Cancers (Basel), 2022; 14(4):985; doi: 10.3390/cancers14040985
7.
PodburyB, GurgenciT, HuggettG, et al.Psychological distress and physical symptoms in advanced cancer: Cross-sectional study. BMJ Support Palliat Care, 2024; doi: 10.1136/spcare-2024-004940
8.
VogtJ, BeyerF, SistermannsJ, et al.; Arbeitsgemeinschaft Palliativmedizin (APM) of the German Cancer Society (DKG). Symptom burden and palliative care needs of patients with incurable cancer at diagnosis and during the disease course. Oncologist, 2021; 26(6):e1058–e1065; doi: 10.1002/onco.13751
9.
PerezB, ArellanoM, LasmariasC, et al.CN72 Symptom burden, quality of life and emotional status of patients with advanced lung cancer seen at the functional lung unit. Ann Oncol, 2023; 34:S1246; doi: 10.1016/j.annonc.2023.09.1665
10.
WoodLD, CantoMI, JaffeeEM, et al.Pancreatic cancer: Pathogenesis, screening, diagnosis, and treatment. Gastroenterology, 2022; 163(2):386–402.e1; doi: 10.1053/j.gastro.2022.03.056
11.
Anonymous. WHO Palliative Care. n.d.
12.
SullivanDR, ChanB, LapidusJA, et al.Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the veterans health administration. JAMA Oncol, 2019; 5(12):1702–1709; doi: 10.1001/jamaoncol.2019.3105
13.
HensonLA, MaddocksM, EvansC, et al.Palliative care and the management of common distressing symptoms in advanced cancer: Pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol, 2020; 38(9):905–914; doi: 10.1200/JCO.19.00470
14.
Anonymous. High-Value palliative care for cancer patients. AMA J Ethics, 2015; 17(11):1064–1072; doi: 10.1001/journalofethics.2015.17.11.pfor3-1511
15.
HinyardLJ, SubramaniamDS, JenkinsAM, et al.Evaluating outcomes for women with metastatic breast cancer: Palliative care consultations, hospital charges, and length of stay. Cancers (Basel), 2024; 16(22):3724; doi: 10.3390/cancers16223724
16.
MahSJ, Carter RamirezDM, SchnarrK, et al.Timing of palliative care, end-of-life quality indicators, and health resource utilization. JAMA Netw Open, 2024; 7(10):e2440977; doi: 10.1001/jamanetworkopen.2024.40977
17.
BrueraE, HuiD. Integrating supportive and palliative care in the trajectory of cancer: Establishing goals and models of care. J Clin Oncol, 2010; 28(25):4013–4017; doi: 10.1200/JCO.2010.29.5618
18.
GlajchenM, GoehringA, JohnsH, et al.Family meetings in palliative care: Benefits and barriers. Curr Treat Options Oncol, 2022; 23(5):658–667; doi: 10.1007/s11864-022-00957-1
19.
TemelJS, GreerJA, MuzikanskyA, et al.Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med, 2010; 363(8):733–742; doi: 10.1056/NEJMoa1000678
20.
KimS, ChervuN, PremjiA, et al.Association of inpatient palliative care consultation with clinical and financial outcomes for pancreatic cancer. Ann Surg Oncol, 2024; 31(2):1328–1335; doi: 10.1245/s10434-023-14528-7
21.
Anonymous. Surveillance, Epidemiology, and End Results (SEER) Program. [Internet]. n.d.
22.
EngelsEA, PfeifferRM, RickerW, et al.Use of surveillance, epidemiology, and end results-medicare data to conduct case-control studies of cancer among the US elderly. Am J Epidemiol, 2011; 174(7):860–870; doi: 10.1093/aje/kwr146
23.
Nwogu-OnyemkpaE, DongarwarD, SalihuHM, et al.Inpatient palliative care use by patients with sickle cell disease: A retrospective cross-sectional study. BMJ Open, 2022; 12(8):e057361; doi: 10.1136/bmjopen-2021-057361
24.
Anonymous. CDC/ATSDR Social Vulnerability Index U.S. n.d.
HarveyRA, HaydenJD, KamblePS, et al.A comparison of entropy balance and probability weighting methods to generalize observational cohorts to a population: A simulation and empirical example: Entropy and Probability Weighting Methods. Pharmacoepidemiol Drug Saf, 2017; 26(4):368–377; doi: 10.1002/pds.4121
27.
SiegelRL, GiaquintoAN, JemalA. Cancer statistics, 2024. CA Cancer J Clin, 2024; 74(1):12–49; doi: 10.3322/caac.21820
28.
PeeryAF, CrockettSD, MurphyCC, et al.Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology, 2022; 162(2):621–644; doi: 10.1053/j.gastro.2021.10.017
29.
HumphrysE, WalterFM, RubinG, et al.Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: A multi-methods study. BJGP Open, 2020; 4(1):bjgpopen20X101001; doi: 10.3399/bjgpopen20X101001
30.
KhanMMM, MunirMM, WoldesenbetS, et al.Association of COVID-19 pandemic with colorectal cancer screening: Impact of race/ethnicity and social vulnerability. Ann Surg Oncol, 2024; 31(5):3222–3232; doi: 10.1245/s10434-024-15029-x
31.
EarleCC, LandrumMB, SouzaJM, et al.Aggressiveness of cancer care near the end of life: Is it a quality-of-care issue? J Clin Oncol, 2008; 26(23):3860–3866; doi: 10.1200/JCO.2007.15.8253
32.
EarleCC, NevilleBA, LandrumMB, et al.Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care, 2005; 17(6):505–509; doi: 10.1093/intqhc/mzi061
33.
MaZ, LiH, ZhangY, et al.Prevalence of aggressive care among patients with cancer near the end of life: A systematic review and meta-analysis. EClinicalMedicine, 2024; 71:102561; doi: 10.1016/j.eclinm.2024.102561
34.
BrueraE, YennurajalingamS. Palliative care in advanced cancer patients: How and when? Oncologist, 2012; 17(2):267–273; doi: 10.1634/theoncologist.2011-0219
35.
MayP, GarridoMM, Del FabbroE, et al.Evaluating hospital readmissions for persons with serious and complex illness: A competing risks approach. Med Care Res Rev, 2020; 77(6):574–583; doi: 10.1177/1077558718823919
36.
DiMartinoLD, WeinerBJ, HansonLC, et al.Inpatient palliative care consultation and 30-day readmissions in oncology. J Palliat Med, 2018; 21(1):62–68; doi: 10.1089/jpm.2017.0172
37.
O’ConnorNR, MoyerME, BehtaM, et al.The impact of inpatient palliative care consultations on 30-day hospital readmissions. J Palliat Med, 2015; 18(11):956–961; doi: 10.1089/jpm.2015.0138
38.
MajkaES, TruegerNS. Emergency department visits among patients with cancer in the US. JAMA Netw Open, 2023; 6(1):e2253797; doi: 10.1001/jamanetworkopen.2022.53797
39.
RoemerM, (AHRQ). Cancer-Related Hospitalizations for Adults, 2017. HCUP Statistical Brief #270. January 2021. Agency for Healthcare Research and Quality, Rockville, MD. n.d.
40.
GonzalezR, SrinivasS, WatermanBL, et al.Impact of early vs late palliative care referrals on healthcare utilization in patients with pancreatic cancer. J Cancer Res Clin Oncol, 2023; 149(16):14997–15002; doi: 10.1007/s00432-023-05113-2
41.
AltafA, WoldesenbetS, MunirMM, et al.Clinical outcomes, costs, and value of surgery among older patients with colon cancer at US news and world report ranked versus unranked hospitals. Ann Surg Oncol, 2024; 31(13):8517–8529; doi: 10.1245/s10434-024-16217-5
42.
RiceDR, FarooqA, HyerJM, et al.Health expenditures and financial burden among patients with major gastrointestinal cancers relative to other common cancers in the United States. Surgery, 2020; 167(6):985–990; doi: 10.1016/j.surg.2020.02.029
43.
WorkuEB, KhalilM, WoldesenbetS, et al.Variation in cost centers following gastrointestinal cancer surgery. Ann Surg Oncol, 2025; 32(3):1565–1574; doi: 10.1245/s10434-024-16531-y
44.
TriplettDP, LeBrettWG, BryantAK, et al.Effect of palliative care on aggressiveness of end-of-life care among patients with advanced cancer. J Oncol Pract, 2017; 13(9):e760–e769; doi: 10.1200/JOP.2017.020883
45.
JangRW, KrzyzanowskaMK, ZimmermannC, et al.Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer. J Natl Cancer Inst, 2015; 107(3):dju424; doi: 10.1093/jnci/dju424
46.
WrightAA, ZhangB, RayA, et al.Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 2008; 300(14):1665–1673; doi: 10.1001/jama.300.14.1665
47.
MorrisonRS, PenrodJD, CasselJB, et al.; Palliative Care Leadership Centers’ Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med, 2008; 168(16):1783–1790; doi: 10.1001/archinte.168.16.1783
48.
SheridanPE, LeBrettWG, TriplettDP, et al.Cost savings associated with palliative care among older adults with advanced cancer. Am J Hosp Palliat Care, 2021; 38(10):1250–1257; doi: 10.1177/1049909120986800
49.
SmithS, BrickA, O’HaraS, et al.Evidence on the cost and cost-effectiveness of palliative care: A literature review. Palliat Med, 2014; 28(2):130–150; doi: 10.1177/0269216313493466
50.
KhandelwalN, KrossEK, EngelbergRA, et al.Estimating the effect of palliative care interventions and advance care planning on ICU utilization: A systematic review. Crit Care Med, 2015; 43(5):1102–1111; doi: 10.1097/CCM.0000000000000852
51.
FrancoeurAA, ChervuN, MardockAL, et al.Association of palliative care with readmission and resource utilization in patients with ovarian cancer: A national perspective. Am J Hosp Palliat Care, 2025; 42(10):997–1004; doi: 10.1177/10499091241301753
52.
NolazcoJI, ChangSL. The role of health-related quality of life in improving cancer outcomes. J Clin Transl Res, 2023; 9(2):110–114.
53.
IslamN, AtreyaA, NepalS, et al.Assessment of quality of life (QOL) in cancer patients attending oncology unit of a Teaching Hospital in Bangladesh. Cancer Rep (Hoboken), 2023; 6(8):e1829; doi: 10.1002/cnr2.1829
54.
CurrowDC, AgarMR, PhillipsJL. Role of hospice care at the end of life for people with cancer. J Clin Oncol, 2020; 38(9):937–943; doi: 10.1200/JCO.18.02235
55.
BhulaniN, GuptaA, GaoA, et al.Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer. J Gastrointest Oncol, 2018; 9(3):495–502; doi: 10.21037/jgo.2018.03.08
56.
JooMK, YooJW, MojtahediZ, et al.Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric Cancer in the United States from 2009 to 2018 - a nationwide database study. BMC Health Serv Res, 2022; 22(1):20; doi: 10.1186/s12913-021-07404-1
57.
SchoenherrLA, BischoffKE, MarksAK, et al.Trends in hospital-based specialty palliative care in the United States from 2013 to 2017. JAMA Netw Open, 2019; 2(12):e1917043; doi: 10.1001/jamanetworkopen.2019.17043
58.
FerrellBR, TemelJS, TeminS, et al.Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol, 2017; 35(1):96–112; doi: 10.1200/JCO.2016.70.1474
59.
WallerstedtB, BenzeinE, SchildmeijerK, et al.What is palliative care? Perceptions of healthcare professionals. Scand J Caring Sci, 2019; 33(1):77–84; doi: 10.1111/scs.12603
FeegVD, ElebiaryH. Exploratory study on end-of-life issues: Barriers to palliative care and advance directives. Am J Hosp Palliat Care, 2005; 22(2):119–124; doi: 10.1177/104990910502200207
62.
HawleyP. Barriers to access to palliative care. Palliat Care, 2017; 10:1178224216688887; doi: 10.1177/1178224216688887
63.
MunroCL, SavelRH. Aggressive care and palliative care. Am J Crit Care, 2018; 27(2):84–86; doi: 10.4037/ajcc2018757
64.
HoergerM, PerryLM, GramlingR, et al.Does educating patients about the Early Palliative Care Study increase preferences for outpatient palliative cancer care? Findings from Project EMPOWER. Health Psychol, 2017; 36(6):538–548; doi: 10.1037/hea0000489
65.
BazarganM, CobbS, AssariS, et al.Awareness of palliative care, hospice care, and advance directives in a racially and ethnically diverse sample of California adults. Am J Hosp Palliat Care, 2021; 38(6):601–609; doi: 10.1177/1049909121991522
66.
GivlerA, BhattH, Maani-FogelmanP. The Importance of Cultural Competence in Pain and Palliative Care. StatPearls Publishing; 2024.
67.
Noncommunicable Diseases, Rehabilitation and Disability (NCD). Improving Access to Palliative Care. WHO, 2019.
68.
CourtrightKR, MaddenV, BayesB, et al.Default palliative care consultation for seriously ill hospitalized patients: A pragmatic cluster randomized trial. JAMA, 2024; 331(3):224–232; doi: 10.1001/jama.2023.25092
69.
AldridgeMD, HasselaarJ, GarraldaE, et al.Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med, 2016; 30(3):224–239; doi: 10.1177/0269216315606645
70.
PuringtonK. Seven Ways State Policymakers Can Promote Palliative Care. n.d.
71.
Anonymous. Modeling of an alternative reimbursement method for palliative care. Am J Manag Care, 2022; 28(6):e221–e227; doi: 10.37765/ajmc.2022.89160
72.
MeierDE, BackAL, BermanA, et al.A national strategy for palliative care. Health Aff (Millwood), 2017; 36(7):1265–1273; doi: 10.1377/hlthaff.2017.0164
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