Impact of Palliative Care Utilization among Kidney Cancer Patients in US Hospitals: A National-Scale Analysis
Main Article Content
Keywords
disparities, kidney cancer, length of stay, palliative care, total costs
Abstract
The objective of this study was to examine the characteristics and utilization patterns of palliative care among the kidney cancer patients using a large-scale representative population-based sample. We retrospectively analyzed National Inpatient Sample hospitalization data from January 2020 to December 2020 to explore disparities in delivering palliative care to deceased kidney cancer patients and assess its impact on healthcare usage, focusing on hospital costs and length of stay (LoS). We used ICD-10 CM codes (International Classification of Diseases-classifying diagnoses and reasons for visits in all healthcare settings) to categorize the study population. We conducted univariable and multivariable linear and logistic regression analyses to calculate coefficients and odds ratios, considering relevant variables and addressing potential confounding factors. We studied 1437 deceased kidney cancer patients, with 53.9% receiving palliative care. Those receiving palliative care had lower total costs ($99,804 vs. $1,34,731) and a shorter LoS (7.19 days vs. 7.66 days), compared to those who didn’t. No significant difference was discovered in LoS. Private insurance, higher income, and female patients were more likely to receive palliative care. Race, hospital teaching status, and hospital size showed no significant differences. This study revealed insights into palliative care use among deceased kidney cancer patients, with cost-saving benefits evident. Disparities showed that individuals with private insurance and higher income more likely accessed palliative care, and females received it more often than males. Physicians and policymakers must consider these findings for equitable resource allocation and improved access.
References
2. Higginson IJ, Finlay IG, Goodwin DM, Hood K, Edwards AG, Cook A, et al. Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?. Journal of pain and symptom management. 2003 Feb 1;25(2):150–68. 10.1016/s0885-3924(02)00599-7
3. Zimmermann C, Riechelmann R, Krzyzanowska M, Rodin G, Tannock I. Effectiveness of specialized palliative care: A systematic review. JAMA. 2008;299(14):1698–709. 10.1001/jama.299.14.1698
4. Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. Journal of the American Geriatrics Society. 2007 Jul;55(7):993–1000. 10.1111/j.1532-5415.2007.01234.x
5. Auerbach AD, Katz R, Pantilat SZ, Bernacki R, Schnipper J, Kaboli P, et al. Factors associated with discussion of care plans and code status at the time of hospital admission: results from the Multicenter Hospitalist Study. Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine. 2008 Nov;3(6):437–45. 10.1002/jhm.369
6. Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med. 1993;328(15):1092–96. 10.1056/NEJM199304153281506
7. Haun MW, Estel S, Rücker G, Friederich HC, Villalobos M, Thomas M, et al. Early palliative care for adults with advanced cancer. Cochrane Database of Systematic Reviews. 2017(6). 10.1002/14651858.CD011129.pub2
8. Fulton JJ, LeBlanc TW, Cutson TM, Porter Starr KN, Kamal A, Ramos K, et al. Integrated outpatient palliative care for patients with advanced cancer: a systematic review and meta-analysis. Palliative medicine. 2019 Feb;33(2):123–34. 10.1177/0269216318812633
9. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology. 2017;35(1):96–112. 10.1200/JCO.2016.70.1474
10. Castro JA, Hannon B, Zimmermann C. Integrating palliative care into oncology care worldwide: The right care in the right place at the right time. Curr Treat Options Oncol. 2023;24(4):353–72. 10.1007/s11864-023-01060-9
11. Connor SR, Morris C, Jaramillo E, Harding R, Clearly J, Haste B, et al. Global Atlas of Palliative Care, 2nd ed. [Internet]. [cited 2020]. Available from: https://www.thewhpca.org/resources/global-atlas-on-end-of-life-care
12. French M, Keegan T, Anestis E, Preston N. Exploring socioeconomic inequities in access to palliative and end-of-life care in the UK: A narrative synthesis [published correction appears in BMC Palliat Care. 2021 Dec 12;20(1):188]. BMC Palliat Care. 2021, Nov 21;20(1):179. 10.1186/s12904-021-00878-0
13. Islam JY, Braithwaite D, Zhang D, Guo Y, Tailor TD, Akinyemiju T. Racial and ethnic inequities of palliative care use among advanced non-Small cell lung cancer patients in the US. Cancer Med. 2023;12(7):8567–80. 10.1002/cam4.5538
14. Bazargan M, Cobb S, Assari S, Kibe LW. Awareness of palliative care, hospice care, and advance directives in a racially and ethnically diverse sample of California adults. Am J Hosp Palliat Care. 2021;38(6):601–9. 10.1177/1049909121991522
15. Sutherland N, Ward-Griffin C, McWilliam C, Stajduhar K. Discourses reproducing gender inequities in hospice palliative home care. Can J Nurs Res. 2018;50(4):189–201. 10.1177/0844562118788239
16. American Cancer Society. Cancer Facts & Figures 2023. Kennesaw, GA: American Cancer Society; 2023.
17. Patel HV, Kim S, Srivastava A, Shinder BM, Sterling J, Saraiya B, Mayer TM, Ghodoussipour S, Jang TL, Singer EA. Factors associated with palliative intervention utilization for metastatic renal cell carcinoma. Clinical Genitourinary Cancer. 2022 Jun 1;20(3):296. 10.1016/j.clgc.2022.01.001
18. Agency for Healthcare Research and Quality (AHRQ). Overview of HCUP [Internet]. [cited 2022]. Available from: https://www.hcup-us.ahrq.gov/overview.jsp. Accessed: October 13, 2023.
19. Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, et al. Adherence to methodological standards in research using the national inpatient sample. Jama. 2017 Nov 28;318(20):2011–8. 10.1001/jama.2017.17653
20. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288–94. 10.1016/j.jclinepi.2004.03.012
21. Center to Advance Palliative Care. Growth of palliative care in US hospitals: Palliative in practice [Internet]. [cited 2022]. Available from: https://www.capc.org/blog/capc-releases-its-growth-of-palliative-care-in-us-hospitals-2022. Accessed: October 11, 2023.
22. Gupta K, Hans B, Khan A, Sohail SH, Kapuria D. A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in the United States. World J Hepatol. 2022;14(9):1817–29. 10.4254/wjh.v14.i9.1817
23. Chang J, Han KT, Medina M, Kim SJ. Palliative care and healthcare utilization among deceased metastatic lung cancer patients in US hospitals. BMC Palliat Care. 2022, Jul 27;21(1):136. 10.1186/s12904-022-01026-y
24. Bowers SP, Chin M, O’Riordan M, Carduff E. The end-of-life experiences of people living with socio-economic deprivation in the developed world: An integrative review. BMC Palliat Care. 2022, Nov 5;21(1):193. 10.1186/s12904-022-01080-6
25. Saeed F, Hoerger M, Norton SA, Guancial E, Epstein RM, Duberstein PR. Preference for palliative care in cancer patients: are men and women alike?. Journal of pain and symptom management. 2018 Jul 1;56(1):1–6. 10.1016/j.jpainsymman.2018.03.014
26. Chen G, Hong YR, Wilkie DJ, Kittleson S, Huo J, Bian J. Geographic variation in knowledge of palliative care among US adults: Findings from 2018 Health Information National Trends Survey. Am J Hosp Palliat Care. 2021;38(3):291–9. 10.1177/1049909120946266