Abstract
Introduction
Primary brain malignancies (PBMs) pose significant morbidity and poor prognosis. Despite NCCN recommendations that palliative care should be integrated into general oncologic care plans, it has been historically underused in patients with PBM. We sought to examine trends and factors associated with inpatient palliative care use in patients with PBM.
Methods
Data from the 2007–2016 National (Nationwide) Inpatient Sample was analyzed for descriptive statistics and trends. Multivariable logistic regression was used to identify factors associated with inpatient palliative care in patients with PBMs.
Results
Of the 510,238 observed hospitalizations of adults with PBM in a 10-year period, 37,365 (7.3%) had an associated inpatient palliative care consult. Rates of inpatient palliative care have increased significantly over the 10-year period, from 2.3 in 2007 to 11.9% in 2011. Patients receiving inpatient palliative care were less likely to receive inpatient oncologic treatment such as brain surgery, chemotherapy, or radiation compared to those without palliative care (14.6% with palliative care vs. 42.4% without, p < 0.001). They were more likely to receive life-sustaining treatments such as intubation, mechanical ventilation, tracheostomy, nutritional support, hemodialysis, or CPR (21.0% with palliative care vs. 10.4% without, p < 0.001). Palliative care was associated with decreased cost of admission ($18,602 with palliative care vs. $20,077 without). In a multiple variable logistic regression, age, non-elective admission, comorbidities, history of chemotherapy and radiation, and mechanical ventilation were associated with significantly increased odds of receiving palliative care.
Conclusions
Inpatient palliative care utilization for patients hospitalized with PBM significantly increased between 2007 and 2016, though the service is still underutilized in the context of the severe symptoms and poor prognosis associated with PBM.
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Data availability
This National Inpatient Sample (NIS) dataset is available through the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality.
Code availability
The code generated during the current study is available from the corresponding author upon reasonable request.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sindhu Kubendran and Sharad Goyal. The first draft of the manuscript was written by Sindhu Kubendran and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The NIS dataset is a de-identified database and does not directly involve “human subjects” per federal regulations and guidance. The NIS dataset does not require Institutional Review Board (IRB) approval or exempt determination. All procedures performed in the study were in accordance with the ethical standards of the institutional and national research committee as well as with the 1964 Helsinki declaration and its later amendments.
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Kubendran, S., Schockett, E., Jackson, E. et al. Trends in inpatient palliative care use for primary brain malignancies. Support Care Cancer 29, 6625–6632 (2021). https://doi.org/10.1007/s00520-021-06255-0
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DOI: https://doi.org/10.1007/s00520-021-06255-0