V66: Variation in Hospital-level Utilization of Palliative Interventions for Patients with Advanced Gastrointestinal Cancer near End of Life

Monday, February 28, 2022

5:52 PM – 5:55 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Vivi W. Chen, MD

Resident Physician
Baylor College of Medicine, United States

Disclosure: Disclosure information not submitted.

Participants should be aware of the following financial/non-financial relationships:

Vivi W. Chen, MD: Disclosure information not submitted.

Introduction:

In patients with advanced gastrointestinal (GI) cancer near the end of life (EOL), high symptom burden often necessitates the use of palliative interventions. However, little is currently known about variation in hospital-level use of these interventions.

Methods: A national cohort study of patients with advanced (stage III and IV) GI cancers (esophagus, stomach, small intestine, liver, pancreas, and gallbladder) near EOL (death within 1-year of diagnosis) within the National Cancer Database (2004-2014). Hospitals were stratified into quartiles of reliability-adjusted utilization of palliative intervention. Multivariable Cox shared frailty modeling was used to evaluate the association between hospital-level palliative intervention use and risk of death within the last year of life.

Results: Overall, 1,322 hospitals treating 142,304 patients were included. Median hospital palliative intervention utilization was 12.0% [IQR 5.1-20.8%]. Palliative intervention use was 32.6% in the highest utilizing hospitals and 2.8% in the lowest utilizing hospitals. At the highest utilizing hospitals, chemotherapy was the most commonly used palliative intervention (35.3%) while radiation therapy was least frequent (13.4%). By contrast, at the lowest utilizing hospitals radiation therapy was most common (30.0%) and combination therapy was least common (8.6%). Over time, palliative intervention use significantly increased at the highest utilizing hospitals (27.2% in 2004 vs 34.6% in 2014; trend test, p< 0.001) while there was no change in utilization at the lowest utilizing hospitals (Figure 1). Relative to the lower-utilizing hospitals, only care at the highest utilizing hospitals was associated with a significantly lower risk of death in the last year of life (HR: 0.97, 95% CI [0.95 – 0.98]).

Conclusions: Significant variation exists in palliative intervention use across hospitals—variation potentially associated with differences in patient outcomes near the EOL. Future work is needed to understand whether there are differences in care processes across hospitals that translate to improved quantity and/or quality of life for patients with advanced GI cancer near EOL.

Learning Objectives:

Upon completion, participants will be able to define gaps in current knowledge about hospital usage of palliative interventions for advanced GI cancer near EOL.
Upon completion, participants will be able to describe variations in hospital utilization of palliative care for advanced GI cancer near EOL.
Upon completion, participants will be able to assemble potential differences in care processes in hospitals that impact quality and quantity of life in patients with advanced GI cancer near EOL.