Ten-Year Trends of Utilization of Palliative Care Services and Life-Sustaining Treatments and Hospital Costs Associated With Patients With Terminally Ill Lung Cancer in the United States From 2005 to 2014

Abstract

Background: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. Methods: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. Results: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% ( P < .001). Conclusion: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.

Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective

“…We found that only 6.7% of ECC hospitalizations utilized palliative care services between 2007 and 2016, which was much lower than anticipated, and lower than palliative care use for other similar poor prognosis cancers, such as pancreatic and liver cancer, in the US [ 10 ]. However, similar to findings with other diseases [ 5 , 6 , 7 , 22 ], we also found that palliative care utilization significantly reduced hospital charges and LOS for the ECC patients. Reasons for the reductions in hospital charges include the effective management of the symptoms, the performance of fewer aggressive procedures, and shorter stays in the hospital for patients who receive palliative care services [ 23 ].…”

“…These charges, as well as significant discomfort, could potentially be avoided by engagement with palliative care [ 1 , 2 ], whereby an expert interdisciplinary team consisting of physicians, nurses, social workers, and other specialties work together to alleviate pain as well as psychological and spiritual distress of patients struggling with terminal diseases [ 3 , 4 ]. Palliative care has been associated with reducing hospital charges and length of hospital stay (LOS) [ 1 , 5 , 6 ] since the management of symptoms avoids unnecessary charges and long hospital stays [ 1 , 2 , 3 , 4 ].…”

“…Palliative care utilization has significantly increased in recent years, especially for common poor-prognosis cancers such as pancreatic and lung cancers; however, usage varies by gender, race/ethnicity, educational level, obesity, socioeconomic status, and health insurance type [ 5 , 6 , 7 , 8 , 9 ]. Additionally, cancer patients whose physicians have discussed end-of-life planning are more likely to choose palliation over aggressive care [ 1 , 2 ].…”

The Epidemiology of Adult Tracheostomy in the United States 2002–2017: A Serial Cross-Sectional Study

“…Although decreasing annual proportions of advanced age groups and changing proportions of various comorbidities among RF-IMV tracheostomy discharges seem to suggest evolving selection, in the context of our prior analysis, these changes actually seem to reflect changes in the underlying RF-IMV population in general ( 17 ). Finally, another potential factor playing a role in the decreases in tracheostomies among RF-IMV discharges is greater collaboration with palliative care physicians and earlier initiation of goals of care discussion that preclude decisions to perform tracheostomy in this population ( 18 , 19 ).…”

Palliative Care Consultation and Effect on Length of Stay in a Tertiary-Level Neurological Intensive Care Unit

“…This important finding reflects the growing body of literature that suggests earlier palliative care consultation may correspond to decreased LOS, especially in ICU patients. 10 Although a common perception is that earlier palliative care consultation decreases LOS by guiding family or legal representatives to withdraw of life-sustaining therapy earlier in the hospital course, chi-square analysis (Table 2) showed that hospital mortality was not associated with early or late palliative care consultation. To our knowledge, this study is the first to demonstrate this association, specifically in the neurosurgical population.…”