Trends in Palliative Care, Hospice Utilization, and Outcomes in Hospitalized Pancreatic Cancer Patients: A Nationwide Analysis

Abstract

Background and objective The prognosis of pancreatic cancer (PC) is generally poor. PC responds only modestly to chemotherapy and chemoradiation, and surgical resection remains the only curative option. The risk of recurrence is high. PC patients are encountered in the hospital on initial diagnosis and later for surgeries and complications from PC. We analyzed PC hospitalizations in the United States as reported in the National Inpatient Sample (NIS) database from 2005 to 2011 to determine the extent to which aggressive interventions could be avoided, thereby decreasing the cost of hospitalization. We analyzed trends in palliative care utilization and hospice services. Methods The International Classification of Disease 9th Revision (ICD-9) codes were used to identify diagnoses and procedures performed. Weighted analysis was performed using SPSS Statistics 28.0 (IBM Corp., Armonk, NY). Dispositions at discharge were noted. Complications and procedures performed were also documented. Results A total of 574,522 cases with PC were identified. Trends are reported chronologically (2005 to 2011). Over time, inpatient deaths for PC have decreased (11.2%, 11.1%, 9.8%, 9.8%, 9.5%, 8.4%, 8.1%; p<0.001), and hospice discharges (HD) have increased (10.2%, 11.4%, 11.4%, 12,2%, 12.6%, 12.4%, 12.7%; p<0.001). Palliative care utilization has increased (2.9%, 3.9%, 3.8%, 5.6%, 8.8%, 10.2%, 11.9%; p<0.001). Complications including peritonitis, thrombosis, hypovolemia/shock, and acute kidney injury (AKI) have increased mortality rates and HD. Conclusion There is an increasing trend of palliative care and hospice service utilization among hospitalized PC patients. Until better-targeted treatments and screening become available, mortality and morbidity will remain high. The proportion of patients receiving aggressive interventions remains high and is associated with poor outcomes. It is desirable to conduct palliative care evaluation (PCE) early in patients with advanced disease and avoid aggressive interventions.

Keywords: cancer complications; hospice; mortality; national inpatient sample; outcomes; palliative care; pancreatic cancer.