Use of inpatient palliative care in metastatic urethral cancer

Carolin Siech; Andrea Baudo; Mario de Angelis; Letizia Maria Ippolita Jannello; Francesco Di Bello; Jordan A Goyal; Zhe Tian; Fred Saad; Shahrokh F Shariat; Nicola Longo; Luca Carmignani; Ottavio de Cobelli; Alberto Briganti; Séverine Banek; Philipp Mandel; Luis A Kluth; Felix K H Chun; Pierre I Karakiewicz

doi:10.1016/j.urolonc.2024.03.019

Use of inpatient palliative care in metastatic urethral cancer

Urol Oncol. 2024 Apr 15:S1078-1439(24)00402-2. doi: 10.1016/j.urolonc.2024.03.019. Online ahead of print.

Authors

Carolin Siech¹, Andrea Baudo², Mario de Angelis³, Letizia Maria Ippolita Jannello⁴, Francesco Di Bello⁵, Jordan A Goyal⁶, Zhe Tian⁶, Fred Saad⁶, Shahrokh F Shariat⁷, Nicola Longo⁸, Luca Carmignani⁹, Ottavio de Cobelli¹⁰, Alberto Briganti¹¹, Séverine Banek¹², Philipp Mandel¹², Luis A Kluth¹², Felix K H Chun¹², Pierre I Karakiewicz⁶

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany. Electronic address: siech@med.uni-frankfurt.de.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁶ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁷ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
⁸ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁹ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
¹⁰ Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.
¹¹ Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
¹² Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.

PMID: 38627106
DOI: 10.1016/j.urolonc.2024.03.019

Abstract

Background: In metastatic urethral cancer, temporal trends, and patterns of inpatient palliative care (IPC) use are unknown.

Methods: Relying on the National Inpatient Sample (2006-2019), metastatic urethral cancer patients were stratified according to IPC use. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models (LRM) for the prediction of IPC use were fitted.

Results: Of 1,106 metastatic urethral cancer patients, 199 (18%) received IPC. IPC use increased from 5.8 to 28.0% over time in the overall cohort (EAPC +9.8%; P < 0.001), from <12.5 to 35.1% (EAPC +11.2%; P < 0.001), and from <12.5 to 24.7% (EAPC +9.4%; P = 0.01) in respectively females and males. Lowest IPC rates were recorded in the Midwest (13.5%) vs. highest in the South (22.5%). IPC patients were more frequently female (44 vs. 37%), and more frequently exhibited bone metastases (45 vs. 34%). In multivariable LRM, female sex (multivariable odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05-2.02; P = 0.02), and bone metastases (OR 1.46, 95%CI 1.02-2.10; P = 0.04) independently predicted higher IPC rates. Conversely, hospitalization in the Midwest (OR 0.53, 95%CI 0.31-0.91; P = 0.02), and in the Northeast (OR 0.48, 95%CI 0.28-0.82; P = 0.01) were both associated with lower IPC use than hospitalization in the West.

Conclusion: IPC use in metastatic urethral cancer increased from a marginal rate of 5.8% to as high as 28%. Ideally, differences according to sex, metastatic site, and region should be addressed to improve IPC use rates.

Keywords: In-hospital mortality; Metastatic stage; NIS; Palliative care; Urothelial carcinoma.