Palliative care involvement at the end of life in advanced cancer.

Abstract

12033 Background: High-intensity end-of-life (EoL) care in advanced cancer is common, costly, and often misaligned with patient goals, despite limited survival benefits. Value-based oncology emphasizes high-quality, goal-concordant care while reducing non-beneficial interventions. Palliative care is central to this model, yet its impact on overall spending versus patterns of care intensity near death remains unclear. We evaluated whether palliative care involvement in the final 30 days of life was associated with differences in total expenditures and healthcare resource allocation in patients with advanced cancer. Methods: We conducted a retrospective cohort study of adults with advanced cancer who died within an integrated health system between 2022 and 2025. Palliative care exposure was defined as ≥1 palliative encounter within 30 days of death. Financial data were obtained from enterprise cost-accounting systems; clinical and utilization data were derived from the electronic health record and institutional cancer registry. Outcomes included total 30-day healthcare charges and proportional spending across major service categories reflecting care intensity. Median charges were compared using Wilcoxon rank-sum tests, and spending distributions were analyzed via chi-square tests. Results: Among 1,635 decedents, 195 received palliative care within 30 days of death, a period associated with the highest concentration of EoL healthcare use. Median total 30-day charges did not differ significantly between patients who received palliative care and those who did not ($14,610 vs $17,100; p = 0.054). However, palliative care involvement was associated with a significant shift in spending patterns. Compared with patients without palliative care, those receiving palliative care had a lower proportion of spending on inpatient, procedural, diagnostic, and therapeutic services and a higher proportion on pharmacy, invasive therapeutic, home health, and hospice services. Overall spending distribution differed significantly between groups (p = 0.046). Across the cohort, inpatient and observation services accounted for the largest share of expenditures, followed by pharmacy, procedural, and invasive therapeutic services, with hospice representing a minority of total spending. Conclusions: EoL palliative care involvement was not associated with significant reductions in total healthcare spending but was linked to differences in care intensity, reflected by a redistribution of expenditures from inpatient and procedural services to pharmacy, invasive therapeutic, and home health care. The value of palliative care in oncology lies not in cost savings but in promoting high-quality EoL care that aligns with patient goals and oncology care priorities. Future analyses will include patient-reported outcomes to examine how shifts in care intensity and spending relate to EoL symptom burden, quality of life, and goal-concordant care.