Cancer Management and Research (Oct 2021)
Palliative Care and Life-Sustaining/Local Procedures in Colorectal Cancer in the United States Hospitals: A Ten-Year Perspective
Abstract
Zahra Mojtahedi,1 Ja Seol Koo,1,2 Ji Yoo,3 Pearl Kim,1 Hee-Taik Kang,4 Jinwook Hwang,5 Moon Kyung Joo,6 Jay J Shen1 1Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USA; 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea; 3Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA; 4Department of Family Medicine, Chungbuk National University Hospital, Cheongju, South Korea; 5Department of Cardiovascular and Thoracic Surgery, Korea University Ansan Hospital, Ansan, South Korea; 6Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South KoreaCorrespondence: Ja Seol KooDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, 15355, South KoreaEmail [email protected] J ShenDepartment of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, 89119, USAEmail [email protected]: In recent years, palliative care utilization has been increasing while life-sustaining/local procedures have been declining at the end of life. Palliative care utilization widely varies based on tumor type. Limited information is available on inpatient palliative care in colorectal cancer.Aims: This study investigated inpatient palliative care utilization and its association with patient demographics, hospital charges, and procedures among colorectal cancer patients admitted to US hospitals between 2008 and 2017. Receipt of life-sustaining and local procedures and surgeries were also investigated during the ten years.Methods: Data were extracted from the National inpatient sample (NIS) database containing de-identified information from each hospitalization. Codes V66.7 for ICD-9-CM or Z51.5 for ICD-10-CM were used to find palliative care utilization. Data were analyzed using generalized regression with adjustment for variations in predictors. The Compound Annual Growth Rate (CAGR) was calculated for palliative care and procedures over time.Results: Of the 487,027 colorectal cancer hospitalizations, only 6.04% utilized palliative care. This percentage significantly increased over time from 2.3% in 2008 to 9.3% in 2017 (P< 0.0001). Palliative care utilization sizably decreased hospital charges by $18,010 per hospitalization (P< 0.0001) and was positively associated with female gender, severe disease, and age over 80 years (P≤ 0.05). Palliative care utilization was inversely associated with using life-sustaining and local procedures and surgeries (P< 0.0001). Life-sustaining procedures (intubation, infusion of concentrate nutrients, dialysis, and blood transfusion) and surgeries were decreased over time (P< 0.001).Conclusions: Palliative care utilization increased over time and was inversely associated with hospital charges and performing procedures among colorectal cancer patients. Our findings warrant further research and interventions to increase palliative care utilization in colorectal cancer.Keywords: colorectal cancer, financial burden, hospital charges, palliative care, procedures, public health
