End-of-Life Palliative Care Lowered Utilization for Patients With Cancer

A new study indicates that palliative care can significantly reduce end-of-life hospitalizations and aggressive procedures among Medicare beneficiaries with advanced cancer.

The research, published in the Journal of Oncology Practice, used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to identify Medicare beneficiaries who died of prostate, breast, lung, or colorectal cancer. The study authors divided eligible patients into 2 groups based on whether they had received a consultation with a palliative care provider, and then compared utilization patterns in these groups, both before and after the consult.

Palliative care is often recommended to patients with advanced disease, including cancer, on the basis of literature demonstrating its ability to improve quality of life, patient and family satisfaction, and mood while avoiding aggressive care measures at the end of life. Prior studies have shown that hospital patients who received palliative care received less intensive care at the end of life, but the current research is the first to explore this relationship at the population level.

Based on characteristics like sex, age, and survival time from diagnosis, researchers matched 3290 patients in the SEER database who had received a palliative care consultation to an equal number of patients who had not. The utilization endpoints examined included emergency department (ED) visits, hospitalizations, chemotherapy use or initiation, intensive care unit (ICU) admissions, and invasive procedures like blood transfusion or intubation. These outcomes were assessed both in the 30 days prior to the palliative care consult and in the time from the consultation through death.

The patients in the palliative care group had greater healthcare utilization than their matched counterparts in the period before the consultation, including increased rates of hospitalization, ED visits, ICU admissions, and multiple invasive procedures. However, these patterns were reversed after the consultation, with palliative care patients showing significantly lower rates of these utilization measures than the comparison group. They were also more likely to enroll in hospice and stay in hospice longer.

For instance, the palliative care group was 54% less likely to receive chemotherapy and 35% less likely to begin a new regimen of chemotherapy after the consultation, compared with the nonpalliative care group. Their likelihood of enrolling in hospice was 24% higher, and their mean length spent in hospice was over 4 days longer.

Researchers also examined the effect of a palliative care consult’s timing on utilization. Having an earlier palliative care encounter was linked to greater reductions in chemotherapy use and days hospitalized, as well as an increase in time spent in hospice. A palliative care consult in the last week of life was associated with a 0.5% decrease in chemotherapy use, compared with a 24.3% decrease if the consult had occurred over 8 weeks prior to death.

“Essentially, we found palliative care represents an inflection point in patient care, with higher use of health-care services before palliative care consultation and lower use after,” the study authors wrote. They noted that these findings support the results of single-center studies demonstrating the association between palliative care and lower utilization.

“It’s critically important to validate research in a real-world setting," said study author James Murphy MD, MS, of the University of California, San Diego, in a press release. "Using a representative and diverse cohort of patients, our study shows the practical benefits of palliative care as it is actually implemented in an everyday practice setting.”