P0126 - High Mortality in Colorectal Cancer Patients With Mechanical Ventilation yet Lower Palliative Care Utilization in African American, Low Income, and Rural Area – An Analysis of U.S. National Inpatient Sample
Tien-Chan Hsieh, MD1, Guangchen Zou, MD1, Gin Yi Lee, MD1, Yee Hui Yeo, MD2 1Danbury Hospital, Danbury, CT; 2Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Previous studies have revealed the poor prognosis of mechanical ventilation (MV) in cancer patients. There has been a trend of increased palliative care utility in cancer patients with MV in the United States. We aimed to access the clinical outcome and the predictive factors associated with the use of palliative care in colorectal cancer (CRC) patients after MV.
Methods: This is a retrospective study using National Inpatient Sample with data year 2016-18. We identified CRC, MV, and palliative care consult using the International Classification of Diseases, 10th edition. Multivariable logistic regression was performed to determine the association of variables with CRC. The palliative care utility was estimated in patients who had stayed in the hospital for at least 3 days and passed away.
Results: A total of 616,717 adult patients with mechanical ventilation were identified. Among them, 6,872, or 1.11%, had CRC. The mortality rate was significantly higher in patients with CRC (adjusted odds ratio [aOR]: 1.11, p < 0.001). CRC was also found to be associated with severe sepsis (aOR: 1.57, p < 0.0001) and more palliative encounter (aOR: 1.19, p < 0.0001). Among the CRC patients with mechanical ventilation who passed away after at least 3 days of hospitalization, several factors were associated with significantly higher palliative care utility, such as higher income, urban hospitals, hospital regions other than northeast. African American, lower income, rural hospitals, and hospitals in the northeast were associated with lower odds of receiving palliative care (Figure 1).
Discussion: The outcome of CRC patients after MV was worse than non-CRC population. It may be partially attributed to the higher risk of severe sepsis. The poor prognosis is possibly the reason of more palliative care encounters in CRC. The limited availability of palliative care resources may explain the end-of-life health disparity that we observed in different racial group, income levels, hospital locations, and regions. More studies are required to investigate and address the end-of-life care disparity.
Figure: Figure 1. Multivariate regression analysis for odds of palliative care utilization in CRC patients with MV who had been hospitalized for at least 3 days before death. The x-axis is odds ratio (solid dot) with the reference line and 95% confidence interval (whiskers).
Tien-Chan Hsieh indicated no relevant financial relationships.
Guangchen Zou indicated no relevant financial relationships.
Gin Yi Lee indicated no relevant financial relationships.
Yee Hui Yeo indicated no relevant financial relationships.
Tien-Chan Hsieh, MD1, Guangchen Zou, MD1, Gin Yi Lee, MD1, Yee Hui Yeo, MD2. P0126 - High Mortality in Colorectal Cancer Patients With Mechanical Ventilation yet Lower Palliative Care Utilization in African American, Low Income, and Rural Area – An Analysis of U.S. National Inpatient Sample, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.