Association between Specialist Palliative Care Use and End-of-Life Care in Patients with Metastatic Cancer (RP321)

Outcomes 1. Understand challenges in measuring specialist palliative care use in population-level data.2. Understand evidence for specialist palliative care in improving quality metrics for end-of-life care in cancer care. Key Message In this propensity-matched cohort study of decedents with metastatic cancer, specialist palliative care was associated with significant decreased use of intensive care and chemotherapy at the end of life, and increased overall and earlier hospice use. Specialist palliative care may improve the quality of end-of-life care for patients with cancer. Importance For patients with advanced cancer, high intensity burdensome treatment at the end of life continues to be prevalent. While specialist palliative care has been advocated to improve the quality of care, it is unknown whether its use is associated with decreased treatment intensity at the end of life on a population-level. Objective(s) To determine whether receipt of specialist palliative care is associated with differences in end-of-life quality metrics in patients with metastatic cancer. Scientific Methods Utilized Retrospective cohort study of U.S. hospitals with palliative care programs that participated in the National Palliative Care Registry for the years 2018-2019. Patients age ≥ 65 who died with metastatic cancer, matched in a 1:2 ratio on the propensity to receive specialist palliative care. Outcomes included binary variables measuring use of chemotherapy in the last 14 days of life, use of intensive care unit (ICU) in the last 30 days of life, use of hospice, and hospice enrollment ≥ 3 days. Cox proportional hazards regression was used to assess the impact of specialist palliative care on outcomes. Results After matching, our cohort consisted of 15,878 exposed and 31,756 unexposed patients. Patients exposed to palliative care had lower rates of chemotherapy (1.5% vs. 3.0%) and ICU use (12.2% vs. 14.9%), and higher rates of hospice use (78.2% vs. 61.5%) and hospice enrollment for ≥3 days (72.2% vs. 51.0%). Receipt of specialist palliative care was associated with a decrease in use of chemotherapy in the last 14 days of life (adjusted hazard ratio (aHR) 0.59 [0.50-0.70]) and ICU within the last 30 days of life (aHR 0.86 [0.80-0.92], as well as an increase in hospice use (aHR 1.92 [1.85-1.99]) and hospice enrollment for ≥3 days (aHR 2.00 [1.93-2.07]). Conclusion(s) On a population-level, use of specialist palliative care was associated with improved metrics for quality end-of-life care for patients dying with metastatic cancer. Impact These findings underscore the importance of integrating specialist palliative care into the care of patients with cancer. Keywords Palliative care in oncology/Hospice