PMID- 30181417
OWN - NLM
STAT- MEDLINE
DCOM- 20191028
LR  - 20200309
IS  - 1540-1413 (Electronic)
IS  - 1540-1405 (Print)
IS  - 1540-1405 (Linking)
VI  - 16
IP  - 9
DP  - 2018 Sep
TI  - Use of Inpatient Palliative Care Services in Patients With Advanced Cancer 
      Receiving Critical Care Therapies.
PG  - 1055-1064
LID - 10.6004/jnccn.2018.7039 [doi]
AB  - Background: Invasive mechanical ventilation (IMV), dialysis for acute kidney 
      failure, and other critical care therapies (CCTs) are associated with a high risk 
      for complications in patients with metastatic cancer. Inpatient palliative care 
      (IPC) can assist in assessing patients' preferences for life-prolonging treatment 
      at the end of life. This study investigated the use pattern of IPC, outcomes 
      (in-hospital mortality, length of stay [LOS], discharge destination, and cost of 
      care), and predictors of IPC use in patients with metastatic cancer who received 
      CCTs. We hypothesized that IPC services are underused in this cohort. Methods: In 
      this retrospective cohort study, we used the 2010 California State Inpatient 
      Databases to identify adults with metastatic cancer who received CCTs that are 
      common and reliably coded (IMV, tracheostomy, percutaneous endoscopic gastrostomy 
      tube, dialysis for acute kidney failure, and total parenteral nutrition). We 
      determined IPC use in all patients, in those who received IMV, and across 4 
      cancer subtypes (lung, breast, colorectal, and genitourinary). Outcomes were 
      assessed based on IPC use. Multivariable analyses were used to investigate 
      factors associated with IPC use. Results: We identified 5,862 hospitalizations, 
      19.8% of which used IPC services. IPC use varied across cancer subtypes (lung, 
      28.3%; breast, 22.4%; colorectal, 12.8%; genitourinary, 16.1%; P<.01). Patients 
      who received and did not receive IPC services had high in-hospital mortality 
      rates (63.9% and 29.8%, respectively), and costs of care and LOS were lower in 
      survivors who received IPC compared with those who did not. Predictors of IPC use 
      were lung cancer (vs colorectal or genitourinary cancer), higher comorbidity 
      score, do-not-resuscitate status on admission or within 24 hours of admission, 
      infections (vs cancer-related diagnoses), and higher hospital bed count. 
      Conclusions: Use of IPC was low in the cohort who received CCTs with poor 
      outcomes, although data on outpatient palliative care services is lacking. 
      Predictors of IPC use may be used to identify patients who may benefit from these 
      services.
CI  - Copyright (c) 2018 by the National Comprehensive Cancer Network.
FAU - Loh, Kah Poh
AU  - Loh KP
FAU - Abdallah, Maya
AU  - Abdallah M
FAU - Shieh, Meng-Shiou
AU  - Shieh MS
FAU - Stefan, Mihaela S
AU  - Stefan MS
FAU - Pekow, Penelope S
AU  - Pekow PS
FAU - Lindenauer, Peter K
AU  - Lindenauer PK
FAU - Mohile, Supriya G
AU  - Mohile SG
FAU - Babu, Dilip
AU  - Babu D
FAU - Lagu, Tara
AU  - Lagu T
LA  - eng
GR  - K01 HL114631/HL/NHLBI NIH HHS/United States
GR  - K01 HL114745/HL/NHLBI NIH HHS/United States
GR  - K24 HL132008/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - J Natl Compr Canc Netw
JT  - Journal of the National Comprehensive Cancer Network : JNCCN
JID - 101162515
SB  - IM
CIN - J Natl Compr Canc Netw. 2018 Sep;16(9):1157-1158. PMID: 30181425
MH  - Aged
MH  - Cancer Survivors/psychology/statistics & numerical data
MH  - Critical Care/methods/*statistics & numerical data
MH  - Databases, Factual/statistics & numerical data
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/complications/mortality/pathology/*therapy
MH  - Palliative Care/methods/*statistics & numerical data
MH  - Patient Acceptance of Health Care/psychology/*statistics & numerical data
MH  - Patient Preference/psychology/statistics & numerical data
MH  - Retrospective Studies
MH  - Terminal Care/methods/*statistics & numerical data
MH  - Treatment Outcome
PMC - PMC6553482
MID - NIHMS1029218
COIS- The authors have disclosed that they have no financial interests, arrangements, 
      affiliations, or commercial interests with the manufacturers of any products 
      discussed in this article or their competitors.
EDAT- 2018/09/06 06:00
MHDA- 2019/10/29 06:00
PMCR- 2019/06/06
CRDT- 2018/09/06 06:00
PHST- 2017/12/08 00:00 [received]
PHST- 2018/04/26 00:00 [accepted]
PHST- 2018/09/06 06:00 [entrez]
PHST- 2018/09/06 06:00 [pubmed]
PHST- 2019/10/29 06:00 [medline]
PHST- 2019/06/06 00:00 [pmc-release]
AID - 10.6004/jnccn.2018.7039 [doi]
PST - ppublish
SO  - J Natl Compr Canc Netw. 2018 Sep;16(9):1055-1064. doi: 10.6004/jnccn.2018.7039.