Palliative care utilization and outcomes among hospitalized cancer patients with severe non–cancer-related complications.

Abstract

e24084 Background: Cancer patients hospitalized with acute non-oncologic complications experience substantial morbidity, mortality, and resource utilization. Early palliative care (PC) integration improves quality of life and outcomes. It reduces healthcare utilization in patients with advanced cancer, yet its integration during hospitalizations for severe inpatient complications remains poorly characterized. We evaluated PC utilization and quantified failure-to-transition rates among cancer hospitalizations complicated by acute non-cancer conditions using a nationally representative dataset. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016–2020. Adult cancer-associated hospitalizations complicated by sepsis/septic shock, respiratory failure, acute kidney injury (AKI), end-stage renal disease (ESRD), liver failure/decompensated cirrhosis, gastrointestinal bleeding, cardiogenic shock, or neutropenic fever were included. Palliative care utilization was identified using the ICD-10-CM code Z51.5. Admissions were weighted using discharge weights to generate national estimates. Outcomes included PC utilization, failure-to-transition rate (no PC among eligible admissions), in-hospital mortality, length of stay (LOS), and total hospital charges. Results: A total of 1,182,807 unweighted hospitalizations, representing over 10 million weighted U.S. cancer hospitalizations, met the inclusion criteria. PC rates ranged from 8.0% in neutropenic fever to 30.3% in cardiogenic shock, corresponding to failure-to-transition rates of 69.7%–92.0%. Despite high severity, PC utilization remained limited even among complications with substantial mortality, including cardiogenic shock (44.5% mortality; PC rate 30.3%), respiratory failure (22.1%; 24.9%), and sepsis (18.9%; 22.1%). Mean LOS ranged from 7.4 to 11.2 days, and mean hospital charges exceeded $100,000 across all complication categories, reaching more than $200,000 for cardiogenic shock. Conclusions: Palliative care is markedly underutilized among cancer hospitalizations complicated by acute non-oncologic conditions, even in settings of high mortality, prolonged hospitalizations, substantial healthcare costs, and resource use. Failure-to-transition rates exceed 75% for most complications, highlighting substantial missed opportunities for earlier palliative care integration during acute, high-risk admissions. These findings support targeted inpatient triggers to improve timely PC engagement during severe complications in hospitalized cancer patients.