Login to Access Video or Poster Abstract: MP14-14
Sources of Funding: St. Louis University, Division of Urology

Introduction

As the nation grapples to control the ballooning cost of end-of-life care, palliative consultation services have gained traction as a potential solution for a patient-centered, cost-effective approach. NCCN guidelines recommend palliative care specialists get involved early and studies have shown improvements in quality of life and lower costs, lengths of stay, and in-hospital mortality. However, studies of palliative care services in prostate cancer are lacking. Regardless, prostate cancer is thought to be particularly amenable for palliative care with its slow course and significant morbidity affecting multiple domains of life. Our objective was to characterize the use of palliative care for patients with metastatic prostate cancer and identify its associations with costs, hospital course, and discharge.

Methods

Using the National Inpatient Sample database from 2012-2013, we identified 99,070 patients with metastatic prostate cancer and analyzed the data from their hospital admissions using descriptive statistics, chi-squared analysis, and regression modeling.

Results

Palliative care services were consulted in 10.4% (10,300) of metastatic prostate cancer admissions. These admissions were associated with non-elective origin, acute complications, and reduced surgical procedures and chemotherapy. Most consultations occurred in non-profit or government-owned large urban hospitals. Costs and charges were only marginally lower (2-5%), length-of-stay was longer, and in-house mortality was significantly increased. Controlling for factors including demographics, inpatient palliative care was more closely associated with patients having DNR orders (OR: 5.25), radiation therapy (OR: 1.67), self-pay (OR: 1.99), and being discharged to home (OR: 15.25), home health (OR: 3.85), or other facilities like hospice care centers (OR: 3.90).

Conclusions

Palliative care consultation could improve care for patients with metastatic prostate cancer in a different manner than observed in other conditions. Longer lengths of stay and minor cost savings are unexpected, but likely reflect the nature of the disease. The lower rates of invasive procedures and higher rates of DNRs and home-health/ hospice discharges suggest some level of end-of-life planning. With our characterization of the incidence, patient factors, and settings where palliative care consultations occur we can conclude that there is room to expand palliative care's role beyond uninsured patients in large, urban teaching-hospitals.

Funding

St. Louis University, Division of Urology