The role and timing of palliative medicine consultation for women with gynecologic malignancies: Association with end of life interventions and direct hospital costs

Abstract

Objective Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. Methods A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher's Exact, Mann–Whitney U, Kaplan–Meier, and Student's T testing. Results 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720), p = 0.01. Conclusions Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.

Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients

“…Our data suggest that patient with high symptom burden may be an appropriate group to consider for standardized palliative care consultation. Our data also add to the growing body of literature supporting the benefits of early integration of palliative care, both earlier rather than later in the disease course [32,[38][39][40] and earlier rather than later in the course of hospitalizations [41][42]. In our cohort, 72% of palliative care consultations happened the day of or the day after admission.…”

Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic cancers

“…In a multivariate analysis involving age, staging, tumor type and race, receiving PC in a timely manner was the only significant predictor of fewer invasive measures at the end of life. Besides, those who were consulted by palliative care staff ≥30 days before death received less invasive measures at the end of life and were associated with lower direct hospital costs [31].…”

Impact of Inpatient Palliative Care on Treatment Intensity for Patients with Serious Illness

“…1 This population of seriously ill older adults receives treatment at the end of life that is often of high intensity, 2-4 but has not been clearly linked to higher quality. [3][4][5][6][7][8] Studies have shown that palliative care is associated with increased quality and decreased treatment intensity at the end of life, [9][10][11] specifically demonstrating reduced intensive care unit (ICU) utilization [12][13][14][15][16][17] and increased hospice utilization. [18][19][20] Most hospitals with more than 50 beds have a palliative care program, yet much variation by state and hospital type remains.…”