PMID- 31693981 OWN - NLM STAT- MEDLINE DCOM- 20200713 LR - 20200713 IS - 1540-1413 (Electronic) IS - 1540-1405 (Linking) VI - 17 IP - 11 DP - 2019 Nov 1 TI - Trends and Social Barriers for Inpatient Palliative Care in Patients With Metastatic Bladder Cancer Receiving Critical Care Therapies. PG - 1344-1352 LID - jnccn18308 [pii] LID - 10.6004/jnccn.2019.7319 [doi] AB - BACKGROUND: Use of inpatient palliative care (IPC) in the treatment of advanced cancer represents a well-established guideline recommendation. A recent analysis showed that patients with genitourinary cancer benefit from IPC at the second lowest rate among 4 examined primary cancers, namely lung, breast, colorectal, and genitourinary. Based on this observation, temporal trends and predictors of IPC use were examined in patients with metastatic urothelial carcinoma of the bladder (mUCB) receiving critical care therapies (CCTs). PATIENTS AND METHODS: Patients with mUCB receiving CCTs were identified within the Nationwide Inpatient Sample database (2004-2015). IPC use rates were evaluated in estimated annual percentage change (EAPC) analyses. Multivariable logistic regression models with adjustment for clustering at the hospital level were used. RESULTS: Of 1,944 patients with mUCB receiving CCTs, 191 (9.8%) received IPC. From 2004 through 2015, IPC use increased from 0.7% to 25.0%, respectively (EAPC, +23.9%; P<.001). In analyses stratified according to regions, the highest increase in IPC use was recorded in the Northeast (EAPC, +44.0%), followed by the West (EAPC, +26.8%), South (EAPC, +22.9%), and Midwest (EAPC, +15.5%). Moreover, the lowest rate of IPC adoption in 2015 was recorded in the Midwest (14.3%). In multivariable logistic regression models, teaching status (odds ratio [OR], 1.97; P<.001), more recent diagnosis (2010-2015; OR, 3.89; P<.001), and presence of liver metastases (OR, 1.77; P=.02) were associated with higher IPC rates. Conversely, Hispanic race (OR, 0.42; P=.03) and being hospitalized in the Northeast (OR, 0.36; P=.01) were associated with lower rate of IPC adoption. Finally, patients with a primary admission diagnosis that consisted of infection (OR, 2.05; P=.002), cardiovascular disorders (OR, 2.10; P=.03), or pulmonary disorders (OR, 2.81; P=.005) were more likely to receive IPC. CONCLUSIONS: The rate of IPC use in patients with mUCB receiving CCTs sharply increased between 2004 and 2015. The presence of liver metastases, infections, or cardiopulmonary disorders as admission diagnoses represented independent predictors of higher IPC use. Conversely, Hispanic race, nonteaching hospital status, and hospitalization in the Midwest were identified as independent predictors of lower IPC use and represent targets for efforts to improve IPC delivery in patients with mUCB receiving CCT. FAU - Mazzone, Elio AU - Mazzone E AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. AD - Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, and. AD - Vita-Salute San Raffaele University, Milan, Italy. FAU - Knipper, Sophie AU - Knipper S AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. AD - Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Mistretta, Francesco A AU - Mistretta FA AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. AD - Department of Urology, European Institute of Oncology, Milan, Italy. FAU - Palumbo, Carlotta AU - Palumbo C AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. AD - Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. FAU - Tian, Zhe AU - Tian Z AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. FAU - Gallina, Andrea AU - Gallina A AD - Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, and. AD - Vita-Salute San Raffaele University, Milan, Italy. FAU - Tilki, Derya AU - Tilki D AD - Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. AD - Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Shariat, Shahrokh F AU - Shariat SF AD - Department of Urology, Medical University of Vienna, Vienna, Austria; and. FAU - Montorsi, Francesco AU - Montorsi F AD - Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, and. AD - Vita-Salute San Raffaele University, Milan, Italy. FAU - Saad, Fred AU - Saad F AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. AD - Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada. FAU - Briganti, Alberto AU - Briganti A AD - Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, and. AD - Vita-Salute San Raffaele University, Milan, Italy. FAU - Karakiewicz, Pierre I AU - Karakiewicz PI AD - Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. AD - Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada. LA - eng PT - Journal Article PL - United States TA - J Natl Compr Canc Netw JT - Journal of the National Comprehensive Cancer Network : JNCCN JID - 101162515 SB - IM MH - Aged MH - Critical Care/*methods MH - Female MH - Hospitalization/*trends MH - Humans MH - Inpatients MH - Middle Aged MH - Neoplasm Metastasis MH - Palliative Care/*trends MH - Urinary Bladder Neoplasms/*therapy EDAT- 2019/11/07 06:00 MHDA- 2020/07/14 06:00 CRDT- 2019/11/07 06:00 PHST- 2018/11/02 00:00 [received] PHST- 2019/05/15 00:00 [accepted] PHST- 2019/11/07 06:00 [entrez] PHST- 2019/11/07 06:00 [pubmed] PHST- 2020/07/14 06:00 [medline] AID - jnccn18308 [pii] AID - 10.6004/jnccn.2019.7319 [doi] PST - ppublish SO - J Natl Compr Canc Netw. 2019 Nov 1;17(11):1344-1352. doi: 10.6004/jnccn.2019.7319.