Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective
Abstract
:1. Introduction
2. Methods
2.1. Data Source and Study Design
2.2. Study Population and Variables
2.3. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Anandarajah, G.; Mennillo, H.A.; Rachu, G.; Harder, T.; Ghosh, J. Lifestyle Medicine Interventions in Patients With Advanced Disease Receiving Palliative or Hospice Care. Am. J. Lifestyle. Med. 2019, 14, 243–257. [Google Scholar] [CrossRef]
- Balogun, J.A. Emerging Trends and Best Practices in Hospice and Palliative Care. In Contemporary Obstetrics and Gynecology for Developing Countries; Okonofua, F., Balogun, J.A., Odunsi, K., Chilaka, V.N., Eds.; Springer: Cham, Switzerland, 2021. [Google Scholar] [CrossRef]
- Corli, O.; Pellegrini, G.; Bosetti, C.; Riva, L.; Crippa, M.; Amodio, E.; Scaccabarozzi, G. Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. Results from the DEMETRA Study. Int. J. Environ. Res. Public. Health 2020, 17, 8429. [Google Scholar] [CrossRef]
- Barkley, R.; Soobader, M.J.; Wang, J.; Blau, S.; Page, R.D. Reducing Cancer Costs Through Symptom Management and Triage Pathways. J. Oncol. Pract. 2019, 15, e91–e97. [Google Scholar] [CrossRef]
- Hwang, J.; Shen, J.; Kim, S.J.; Chun, S.Y.; Kioka, M.; Sheraz, F.; Kim, P.; Byun, D.; Yoo, J.W. 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. Am. J. Hosp. Palliat. Care. 2019, 36, 1105–1113. [Google Scholar] [CrossRef]
- Liu, X.; Shen, J.J.; Kim, P.; Kim, S.J.; Ukken, J.; Choi, Y.; Hwang, I.C.; Lee, J.H.; Chun, S.Y.; Hwang, J.; et al. Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014. J. Palliat. Care. 2019, 34, 232–240. [Google Scholar] [CrossRef]
- Mulvey, C.L.; Smith, T.J.; Gourin, C.G. Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer. Head Neck 2016, 38, 355–363. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Subramoney, K.; Orman, E.; Johnson, A.W.; Kara, A. The Impact of Obesity in End of Life Care in Patients With End Stage Liver Disease: An Observational Study. Am. J. Hosp. Palliat. Care 2020, 38, 1177–1181. [Google Scholar] [CrossRef] [PubMed]
- Chuang, M.H.; Lee, F.N.; Shiau, Y.T.; Shen, H.Y.; Lee, C.C.; Chen, S.S.; Huang, S.J. Physician Palliative Education Associated With High Use of Hospice Care Service. Am. J. Hosp. Palliat. Care 2021, 10499091211014160. [Google Scholar] [CrossRef]
- Rubens, M.; Ramamoorthy, V.; Saxena, A.; Das, S.; Appunni, S.; Rana, S.; Puebla, B.; Suarez, D.T.; Khawand-Azoulai, M.; Medina, S.; et al. Palliative Care Consultation Trends Among Hospitalized Patients With Advanced Cancer in the United States, 2005 to 2014. Am. J. Hosp. Palliat. Care 2019, 36, 294–301. [Google Scholar] [CrossRef] [PubMed]
- Patel, N.; Benipal, B. Incidence of Cholangiocarcinoma in the USA from 2001 to 2015: A US Cancer Statistics Analysis of 50 States. Cureus 2019, 11, e3962. [Google Scholar] [CrossRef] [Green Version]
- Tantau, A.I.; Mandrutiu, A.; Pop, A.; Zaharie, R.D.; Crisan, D.; Preda, C.M.; Tantau, M.; Mercea, V. Extrahepatic cholangiocarcinoma: Current status of endoscopic approach and additional therapies. World. J. Hepatol. 2021, 13, 166–186. [Google Scholar] [CrossRef]
- Rizzo, A.; Brandi, G. Pitfalls, challenges, and updates in adjuvant systemic treatment for resected biliary tract cancer. Expert. Rev. Gastroenterol. Hepatology 2021, 15, 547–554. [Google Scholar] [CrossRef] [PubMed]
- Moffat, G.T.; Epstein, A.S.; O’Reilly, E.M. Pancreatic cancer-A disease in need: Optimizing and integrating supportive care. Cancer 2019, 125, 3927–3935. [Google Scholar] [CrossRef] [PubMed]
- Mizrahi, J.D.; Surana, R.; Valle, J.W.; Shroff, R.T. Pancreatic cancer. Lancet 2020, 395, 2008–2020. [Google Scholar] [CrossRef]
- Buss, M.K.; Rock, L.K.; McCarthy, E.P. Understanding Palliative Care and Hospice: A Review for Primary Care Providers. Mayo. Clin. Proc. 2017, 92, 280–286. [Google Scholar] [CrossRef] [Green Version]
- Freeman, W.J.; Weiss, A.J.; Heslin, K.C. Overview of U.S. Hospital Stays in 2016: Variation by Geographic Region: Statistical Brief #246. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs; Agency for Healthcare Research and Quality (US): Rockville, MA, USA, 2018; PMID: 30720972. [Google Scholar]
- Bhulani, N.; Gupta, A.; Gao, A.; Li, J.; Guenther, C.; Ahn, C.; Paulk, E.; Houck, S.; Beg, M.S. Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer. J. Gastrointest. Oncol. 2018, 9, 495–502. [Google Scholar] [CrossRef]
- Kohoutová, D.; Bureš, J.; Zar, S.; Urban, O. Carcinoma of Pancreatobiliary Origin. Gastroenterol. Res. Pract. 2020, 4323687. [Google Scholar] [CrossRef]
- Hartman, M.; Martin, A.B.; Benson, J.; Catlin, A.; National Health Expenditure Accounts Team. National Health Care Spending In 2018: Growth Driven By Accelerations In Medicare And Private Insurance Spending. Health. Aff. 2020, 39, 8–17. [Google Scholar] [CrossRef] [PubMed]
- Hartman, M.; Martin, A.B.; Benson, J.; Catlin, A.; National Health Expenditure Accounts Team. National health spending in 2011: Overall growth remains low, but some payers and services show signs of acceleration. Health. Aff. 2013, 32, 87–99. [Google Scholar] [CrossRef] [Green Version]
- Macmillan, P.J.; Chalfin, B.; Soleimani Fard, A.; Hughes, S. Earlier Palliative Care Referrals Associated with Reduced Length of Stay and Hospital Charges. J. Palliat. Med. 2020, 23, 107–111. [Google Scholar] [CrossRef]
- Sullender, R.T.; Selenich, S.A. Financial Considerations of Hospital-Based Palliative Care; RTI Press: Research Triangle Park, NC, USA, 2016. [Google Scholar] [CrossRef] [Green Version]
- Janah, A.; Gauthier, L.R.; Morin, L.; Bousquet, P.J.; Le Bihan, C.; Tuppin, P.; Peretti-Watel, P.; Bendiane, M.K. Access to palliative care for cancer patients between diagnosis and death: A national cohort study. Clin. Epidemiol. 2019, 11, 443–455. [Google Scholar] [CrossRef] [Green Version]
- Sabih, A.H.; Laube, R.; Strasser, S.I.; Lim, L.; Cigolini, M.; Liu, K. Palliative medicine referrals for hepatocellular carcinoma: A national survey of gastroenterologists. BMJ. Support. Palliat. Care 2021. [Google Scholar] [CrossRef]
- Schoenherr, L.A.; Bischoff, K.E.; Marks, A.K.; O’Riordan, D.L.; Pantilat, S.Z. Trends in Hospital-Based Specialty Palliative Care in the United States From 2013 to 2017. JAMA Netw. Open 2019, 2, e1917043. [Google Scholar] [CrossRef] [Green Version]
- Parikh, R.B.; Wright, A.A. The Affordable Care Act and End-of-Life Care for Patients With Cancer. Cancer J. 2017, 23, 190–193. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cai, J.; Zhang, L.; Guerriere, D.; Fan, H.; Coyte, P.C. Where Do Cancer Patients in Receipt of Home-Based Palliative Care Prefer to Die and What Are the Determinants of a Preference for a Home Death? Int. J. Environ. Res. Public. Health 2020, 18, 235. [Google Scholar] [CrossRef]
- Surkan, M.J.; Gibson, W. Interventions to Mobilize Elderly Patients and Reduce Length of Hospital Stay. Can. J. Cardiol. 2018, 34, 881–888. [Google Scholar] [CrossRef] [PubMed]
- Lee, K.; Gani, F.; Canner, J.K.; Johnston, F.M. Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies. Am. J. Hosp. Palliat. Care 2021, 38, 539–546. [Google Scholar] [CrossRef]
- Giglia, M.D.; DeRussy, A.; Morris, M.S.; Richman, J.S.; Hawn, M.T.; Vickers, S.M.; Knight, S.J.; Chu, D.I. Racial disparities in length-of-stay persist even with no postoperative complications. J. Surg. Res. 2017, 214, 14–22. [Google Scholar] [CrossRef]
- Haines, E.R.; Frost, A.C.; Kane, H.L.; Rokoske, F.S. Barriers to accessing palliative care for pediatric patients with cancer: A review of the literature. Cancer 2018, 124, 2278–2288. [Google Scholar] [CrossRef] [Green Version]
- Hui, D.; De La Rosa, A.; Chen, J.; Delgado Guay, M.; Heung, Y.; Dibaj, S.; Liu, D.; Bruera, E. Palliative care education and research at US cancer centers: A national survey. Cancer 2021, 127, 2139–2147. [Google Scholar] [CrossRef]
- Feder, S.L.; Redeker, N.S.; Jeon, S.; Schulman-Green, D.; Womack, J.A.; Tate, J.P.; Bedimo, R.J.; Budoff, M.J.; Butt, A.A.; Crothers, K.; et al. Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration. Am. J. Hosp. Palliat. Care 2018, 35, 959–965. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Al-Zahir, M.Z.; AlAmeel, T. Extrahepatic cholangiocarcinoma with prolonged survival: A case report. J. Med. Case. Rep. 2017, 11, 357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Characteristics | 2007–2016 | 2007 | 2010 | 2013 | 2016 | |
---|---|---|---|---|---|---|
Age in years (mean ± SD) | 70.7 ± 27.6 | 71.1 ± 29.4 | 71.0 ± 26.3 | 70.0 ± 28.4 | 70.1 ± 29.0 | |
Age group | <50 | 1157 (5.2) | 106 (6.0) | 109 (3.9) | 155 (6.6) | 130 (6.3) |
50–59 | 2826 (12.9) | 275 (15.7) | 378 (13.4) | 264 (11.3) | 250 (12.2) | |
60–69 | 5629 (25.6) | 352 (20.1) | 746 (26.4) | 664 (28.3) | 524 (25.6) | |
70–79 | 6374 (29.0) | 457 (26.0) | 846 (29.9) | 639 (27.3) | 599 (29.3) | |
≥80 | 5974 (27.2) | 564 (32.2) | 744 (26.3) | 619 (26.4) | 544 (26.6) | |
Gender | Female | 9842 (44.8) | 781 (44.4) | 1258 (44.5) | 1039 (44.4) | 879 (43) |
Male | 12,119 (55.2) | 978 (55.6) | 1566 (55.6) | 1305 (55.6) | 1170 (57) | |
Race/Ethnicity | White | 15,551 (70.8) | 1291 (73.4) | 1964 (69.6) | 1714 (73.1) | 1445 (70.5) |
Black | 1980 (9.0) | 166 (9.5) | 305 (10.8) | 254 (10.9) | 160 (7.8) | |
Hispanic | 2299 (10.4) | 197 (11.2) | 328 (11.6) | 239 (10.2) | 239 (11.7) | |
API | 1114 (5.0) | 61 (3.5) | 142 (5.0) | 45 (1.9) | 100 (4.9) | |
Other | 1015 (4.6) | 43 (2.4) | 83 (3.0) | 89 (3.8) | 104 (5.2) | |
Insurance/Payer Source | Medicare | 14,123 (64.3) | 1139 (64.8) | 1814 (64.2) | 1534 (65.5) | 1335 (65.1) |
Medicaid | 1528 (6.9) | 108 (6.2) | 167 (5.9.5) | 195 (8.3) | 170 (8.3) | |
Private insurance | 5276 (24.0) | 414 (23.5) | 663 (23.5) | 535 (22.8) | 460 (22.4) | |
Self-pay | 547 (2.4) | 54 (3.09) | 109 (3.9) | 34 (1.5) | 44 (2.2) | |
Other | 486 (2.2) | 42 (2.43) | 69 (2.5) | 45 (1.9) | 39 (2.0) | |
Severity of illness (APR-DRG) | 0–1, lowest | 893 (4.0) | 116 (6.6) | 162 (5.7) | 54 (2.3) | 94 (4.6) |
2, moderate | 6417 (29.2) | 536 (30.4) | 838 (29.7) | 640 (27.3) | 749 (36.6) | |
3, major | 11,118 (50.7) | 836 (47.6) | 1352 (47.9) | 1349 (57.6) | 929 (45.4) | |
4, extreme | 3532 (16.1) | 270 (15.4) | 471 (16.7) | 299 (12.8) | 275 (13.4) | |
Received palliative care services | 1478 (6.7) | 63 (2.5) | 180 (6.3) | 190 (8.1) | 184 (9.0) | |
In-hospital death | 1196 (5.4) | 139 (7.9) | 174 (6.1) | 80 (3.4) | 84 (4.1) | |
Of these, received palliative care | 394 (32.9) | 24 (17.3) | 58 (33.6) | 40 (50.0) | 40 (47.0) | |
LOS in days (mean ± SD) | 8.5 ± 17.4 | 9.3 ±19.5 | 8.6 ± 16.6 | 8.0 ± 16.0 | 7.6 ± 14.2 | |
Total charges in USD (mean ± SD) | 83,042 ± 217,330 | 64,128 ± 159,902 | 83,048 ± 194,879 | 82,765 ± 191,909 | 96,063 ± 217,468 |
Odds Ratio | 95% CI | p-Value | ||
---|---|---|---|---|
Year | 1.19 | 0.99–1.42 | 0.060 | |
Age group | 50–60 | reference | ||
<50 | 0.67 | 0.28–1.62 | 0.378 | |
60–70 | 0.68 | 0.37–1.24 | 0.212 | |
70–80 | 0.79 | 0.42–1.50 | 0.480 | |
>80 | 2.13 | 1.13–4.02 | 0.018 | |
Gender | Male | reference | ||
Female | 1.38 | 1.00–1.90 | 0.050 | |
Race/Ethnicity | White | reference | ||
API | 0.73 | 0.33–1.62 | 0.450 | |
Black | 0.96 | 0.55–1.68 | 0.894 | |
Hispanic | 0.82 | 0.47–1.45 | 0.508 | |
Insurance/Payer Source | Private insurance | reference | ||
Medicaid | 0.84 | 0.41–1.71 | 0.632 | |
Medicare | 0.72 | 0.44–1.18 | 0.198 | |
Self-pay | 1.22 | 0.44–3.38 | 0.696 | |
Severity of illness: APR-DRG | 2.39 | 1.82–3.13 | <0.001 | |
Died in hospital | 8.46 | 4.51–15.86 | <0.001 |
Coefficient, β | Standard Error | p-Value | ||
---|---|---|---|---|
Year | −0.14 | 0.03 | 0.0004 | |
Received palliative care services | −1.3 | 0.42 | 0.0023 | |
Age group | 50–60 | reference | ||
<50 | 0.67 | 0.54 | 0.2118 | |
60–70 | 0.55 | 0.37 | 0.1426 | |
70–80 | 0.69 | 0.42 | 0.1001 | |
>80 | −0.16 | 0.43 | 0.6996 | |
Gender | Male | reference | ||
Female | −0.26 | 0.21 | 0.2177 | |
Race/Ethnicity | White | reference | ||
API | 0.75 | 0.48 | 0.1234 | |
Black | 1.17 | 0.37 | 0.0017 | |
Hispanic | 0.46 | 0.35 | 0.1891 | |
Insurance/Payer Source | Private insurance | reference | ||
Medicaid | 2.55 | 0.46 | <0.0001 | |
Medicare | 0.68 | 0.31 | 0.0281 | |
Self-pay | 1.23 | 0.69 | 0.0761 | |
Severity of illness: APR-DRG | 3.84 | 0.14 | <0.0001 |
Coefficient, β | Standard Error | p-Value | ||
---|---|---|---|---|
Year | USD 487 | USD 453 | 0.2826 | |
Received palliative care services | USD 25,937 | USD 4378 | <0.0001 | |
Age group | 50–60 | reference | ||
<50 | USD 5576 | USD 5440 | 0.3055 | |
60–70 | USD 5948 | USD 3774 | 0.1151 | |
70–80 | USD 8186 | USD 4207 | 0.0518 | |
>80 | USD (3047) | USD 4335 | 0.4822 | |
Gender | Male | reference | ||
Female | USD 7486 | USD 2132 | 0.0005 | |
Race/Ethnicity | White | reference | ||
API | USD 16,148 | USD 4998 | 0.0013 | |
Black | USD 1108 | USD 3790 | 0.77 | |
Hispanic | USD 12,045 | USD 3678 | 0.0011 | |
Insurance/Payer Source | Private insurance | reference | ||
Medicaid | USD 7302 | USD 4627 | 0.1147 | |
Medicare | USD 1076 | USD 3147 | 0.7325 | |
Self-pay | USD 1262 | USD 6999 | 0.856 | |
Severity of illness: APR-DRG | USD 31,986 | USD 1469 | <0.0001 |
Odds Ratio | 95% CI | p-Value | ||
---|---|---|---|---|
Year | 0.89 | 1.01–1.23 | 0.0480 | |
Received palliative care services | 8.94 | 5.74–13.94 | <0.0001 | |
Age group | 50–60 | reference | ||
<50 | 0.65 | 0.20–2.13 | 0.4856 | |
60–70 | 1.64 | 0.83–3.25 | 0.1518 | |
70–80 | 3.31 | 1.61–6.82 | 0.0011 | |
>80 | 2.56 | 1.23–5.36 | 0.0120 | |
Gender | Male | reference | ||
Female | 0.94 | 0.66–1.33 | 0.7400 | |
Race/Ethnicity | White | reference | ||
API | 0.86 | 0.38–1.96 | 0.7315 | |
Black | 1.11 | 0.62–1.97 | 0.7145 | |
Hispanic | 0.95 | 0.52–1.72 | 0.8750 | |
Insurance/Payer Source | Private insurance | reference | ||
Medicaid | 1.16 | 0.52–2.55 | 0.7103 | |
Medicare | 0.54 | 0.32–0.91 | 0.0214 | |
Self-pay | 1.37 | 0.49–3.82 | 0.5469 | |
Severity of illness: APR-DRG | 4.81 | 3.57–6.48 | <0.0001 |
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Share and Cite
Mojtahedi, Z.; Yoo, J.W.; Callahan, K.; Bhandari, N.; Lou, D.; Ghodsi, K.; Shen, J.J. Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective. Int. J. Environ. Res. Public Health 2021, 18, 10004. https://doi.org/10.3390/ijerph181910004
Mojtahedi Z, Yoo JW, Callahan K, Bhandari N, Lou D, Ghodsi K, Shen JJ. Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective. International Journal of Environmental Research and Public Health. 2021; 18(19):10004. https://doi.org/10.3390/ijerph181910004
Chicago/Turabian StyleMojtahedi, Zahra, Ji Won Yoo, Karen Callahan, Neeraj Bhandari, Donghui Lou, Katayoon Ghodsi, and Jay J. Shen. 2021. "Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective" International Journal of Environmental Research and Public Health 18, no. 19: 10004. https://doi.org/10.3390/ijerph181910004