Early Palliative Care Decreased Healthcare Use at End of Life

Participating in a palliative care consultation significantly decreased healthcare use of Medicare beneficiaries with advanced cancer at the end of life, according to the results of a study published in the Journal of Oncology Practice.

“In this representative sample of Medicare patients with advanced cancer, we found patients who received palliative care experienced significantly less aggressive care, lower rates of hospitalization, increased use of hospice, and fewer invasive procedures near the end of life,” wrote Daniel P. Triplett, of the Moores Cancer Center at the University of California San Diego, and colleagues. “Given the increasing number of elderly patients with advanced cancer, the findings in this study emphasize the important role palliative care plays in global public health.”

The incorporation of palliative care in oncology has increased in the last decade, but there were few data on whether its use affected the aggressiveness of care at the end of life. This study looked at palliative care use at the end of life among 6,580 Medicare beneficiaries. Participants had either advanced prostate, breast, lung, or colorectal cancer. The researchers looked at health care utilization before and after palliative care consultation.

For the 30 days prior to palliative care consultation, the patients who received palliative care had increased use of many healthcare services, including higher rates of hospitalization (risk ratio [RR], 3.33), invasive procedures (RR, 1.75), and chemotherapy administration (RR, 1.61).

However, after receiving a palliative care consultation, healthcare utilization was significantly lower in these patients. Having received palliative care resulted in lower rates of hospitalization (RR, 0.53), invasive procedures (RR, 0.52), and chemotherapy administration (RR, 0.46). In addition, patients who received palliative care were 24% more likely to enroll in hospice.

“Essentially, we found palliative care represents an inflection point in patient care, with higher use of healthcare services before palliative care consultation and lower use after,” the researchers wrote.

Receipt of palliative care consultation earlier in the course of the disease yielded a larger absolute reduction in healthcare use vs consultation closer to end of life.

“These findings are particularly relevant given the current emphasis of early palliative care integration alongside standard oncologic care in patients with advanced cancer,” the researchers wrote. “To date, multiple randomized trials have demonstrated the benefits of early palliative care, which include improved quality of life, improved mood, decreased aggressiveness of end-of-life care, improved survival, and improved patient and caregiver satisfaction.”

The researchers pointed out several potential weaknesses of the study, including the fact that it was not randomized and that they could not measure whether the palliative care consultation resulted from a pre-palliative care decision to de-escalate care.

“If patients make the decision to de-escalate care due to adverse effects, or if they exhaust all treatment options, they may seek palliative consultation, which means the decreased use may reflect a natural transition in care that did not come from the influence of the palliative care consultation itself,” the researchers wrote.