Impact of palliative care on the management and outcomes of elderly pancreatic cancer patients following admissions for acute pulmonary embolism.

Abstract

e16397 Background: Palliative care (PalC) has improved the quality of life of cancer patients by focusing on holistic support, pain management, and emotional and physical well-being. Pancreatic cancers(PC) are well known to cause thromboembolic complications such as acute pulmonary embolism(APE) due to their hypercoagulable state. We aim to understand the role of PalC in therapy and the outcomes of PC patients with APE in the United States. Methods: We analyzed data from the National Inpatient Sample (NIS) for PC patients aged ≥60 who were admitted with a primary diagnosis of APE, excluding those with a coexisting diagnosis of COVID-19. We identified patients who received PalC and compared their demographics and outcomes with those who did not receive PalC. Results: Our sample contained 10280 cases of PC with APE. There were 2050(19.9%) cases who were on PalC and constituted an older group (mean age 73.24 vs. 71.53 years, p < 0.01). The overall presence of PalC grew from 16.7% in 2016 to 23.6% in 2022(ptrend < 0.01). Around 67.1% of the PalC group had a do-not-resuscitate(DNR) order(vs. 21.0% in the non-PalC group). Both groups had a comparative prevalence of a history of pulmonary embolism (4.9% among PalC patients vs. 4.6% among non-PalC patients, p = 0.617). Around 51.4% of the non-PalC and 51.7% of the PalC group were females(p = 0.802). An estimated 83.7% of the PalC group had metastasis of their cancer, while it involved only 68.4% in the non-PalC group (p < 0.01). The PalC patients had higher odds of undergoing percutaneous mechanical thrombectomy(aOR 1.559, 95% CI 1.062-2.288, p = 0.023), but no differences were seen for the use of catheter-based thrombolysis(aOR 0.837, 95% CI 0.508-1.379, p = 0.485), or inferior vena cava (IVC) filter placement(aOR 0.984, 95% CI 0.826-1.171, p = 0.852). PalC was associated with higher mortality (aOR 4.951, 95% CI 4.218-5.812, p < 0.01). They also stayed longer for care with a mean length of stay of 6.33 days (vs. 4.49, p < 0.01) at a higher hospital charge($67980 vs. $51197, p < 0.01). Conclusions: This study highlights an increasing trend in the use of PalC for elderly PC patients with APE. PalC patients were older, had more advanced diseases, and had higher mortality rates. While they were more likely to undergo percutaneous mechanical thrombectomy, other interventions had no significant differences. The extended stay and higher costs associated with PalC reveal the need for further research to improve outcomes in this vulnerable population, focusing on improved quality of life while reducing healthcare costs.