Temporal trends and barriers for inpatient palliative care referral in metastatic gynecologic cancer patients receiving specific critical care therapies

Li Shen; Longpei Chen; Yun Zhou; Tianran Chen; Hedong Han; Qiuyan Xia; Zhanguo Liu

doi:10.3389/fonc.2023.1173438

Temporal trends and barriers for inpatient palliative care referral in metastatic gynecologic cancer patients receiving specific critical care therapies

Front Oncol. 2023 Oct 19:13:1173438. doi: 10.3389/fonc.2023.1173438. eCollection 2023.

Authors

Li Shen¹, Longpei Chen², Yun Zhou³, Tianran Chen², Hedong Han⁴, Qiuyan Xia¹, Zhanguo Liu¹

Affiliations

¹ Department of Oncology, the Affiliated Aoyang Hospital of Jiangsu University, Zhangjiagang, China.
² Department of Oncology, Changhai Hospital, Naval Medical University, Shanghai, China.
³ Department of Radiation Oncology, the Affiliated Aoyang Hospital of Jiangsu University, Zhangjiagang, China.
⁴ Department of Health Statistics, Naval Medical University, Shanghai, China.

Abstract

Objective: Existing evidence suggests that palliative care (PC) is highly underutilized in metastatic gynecologic cancer (mGCa). This study aims to explore temporal trends and predictors for inpatient PC referral in mGCa patients who received specific critical care therapies (CCT).

Methods: The National Inpatient Sample from 2003 to 2015 was used to identify mGCa patients receiving CCT. Basic characteristics were compared between patients with and without PC. Annual percentage change (APC) was estimated to reflect the temporal trend in the entire cohort and subgroups. Multivariable logistic regression was employed to explore potential predictors of inpatient PC referral.

Results: In total, 122,981 mGCa patients were identified, of whom 10,380 received CCT. Among these, 1,208 (11.64%) received inpatient PC. Overall, the rate of PC referral increased from 1.81% in 2003 to 26.30% in 2015 (APC: 29.08%). A higher increase in PC usage was found in white patients (APC: 30.81%), medium-sized hospitals (APC: 31.43%), the Midwest region (APC: 33.84%), and among patients with ovarian cancer (APC: 31.35%). Multivariable analysis suggested that medium bedsize, large bedsize, Midwest region, West region, uterine cancer and cervical cancer were related to increased PC use, while metastatic sites from lymph nodes and genital organs were related to lower PC referral.

Conclusion: Further studies are warranted to better illustrate the barriers for PC and finally improve the delivery of optimal end-of-life care for mGCa patients who receive inpatient CCT, especially for those diagnosed with ovarian cancer or admitted to small scale and Northeast hospitals.

Keywords: barriers; critical care therapies; metastatic gynecologic cancer; palliative care; trends.