Utilization of palliative care resource remains low, consuming potentially avoidable hospital admissions in stage IV non-small cell lung cancer: a community-based retrospective review.

Publication Title

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

Authors

Austin M Meggyesy, Center for Lung Research in Honor of Wayne Gittinger, Swedish Medical Center and Cancer Institute, Seattle, Washington, USAFollow
Kerrie E Buehler, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 850, Seattle, WA, 98104, USA.
Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Shih-Ting Chiu, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St Joseph Health, Portland, OregonFollow
Shu-Ching Chang, Medical Data Research Center, Providence Health & Services, Portland, OR, USAFollow
Joshua R Rayburn, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 850, Seattle, WA, 98104, USA.
Christopher R Gilbert, Swedish Cancer Institute Seattle, WashingtonFollow
Jed A Gorden, Swedish Cancer Institute Seattle, WashingtonFollow

Document Type

Article

Publication Date

12-1-2022

Keywords

washington; swedish; swedish thoracic; oregon; cards; cards publication; Humans; Palliative Care; Carcinoma, Non-Small-Cell Lung; Retrospective Studies; Hospital Mortality; Lung Neoplasms; Hospitalization; Hospitals

Abstract

PURPOSE: Early referral of patients with stage IV non-small cell lung cancer (NSCLC) to outpatient palliative care has been shown to increase survival and reduce unnecessary healthcare resource utilization. We aimed to determine outpatient palliative care referral rate and subsequent resource utilization in patients with stage IV NSCLC in a multistate, community-based hospital network and identify rates and reasons for admissions within a local healthcare system of Washington State.

METHODS: A retrospective chart review of a multistate hospital network and a local healthcare system. Patients were identified using ICD billing codes. In the multistate network, 2844 patients diagnosed with stage IV NSCLC between January 1, 2013, and March 1, 2018, were reviewed. In the state healthcare system, 283 patients between August 2014 and June 2017 were reviewed.

RESULTS: Referral for outpatient palliative care was low: 8% (217/2844) in the multistate network and 11% (32/283) in the local healthcare system. Early outpatient palliative care (6%, 10/156) was associated with a lower proportion of patients admitted into the intensive care unit in the last 30 days of life compared to no outpatient palliative care (15%, 399/2627; p = 0.003). Outpatient palliative care referral was associated with improved overall survival in Kaplan Meier survival analysis. Within the local system, 51% (104/204) of admissions could have been managed in outpatient setting, and of the patients admitted in the last 30 days of life, 59% (87/147) experienced in-hospital deaths.

CONCLUSION: We identified underutilization of outpatient palliative care services within stage IV NSCLC patients. Many patients with NSCLC experience hospitalization the last month of life and in-hospital death.

Area of Special Interest

Cancer

Specialty/Research Institute

Pulmonary Medicine

Specialty/Research Institute

Palliative Care

Specialty/Research Institute

Oncology

DOI

10.1007/s00520-022-07364-0