Early Palliative Care Decreased Health Care Use as Illnesses Progress

Participating in a palliative care consultation significantly decreased health care use of Medicare beneficiaries with advanced cancer, according to the results of a study published in the Journal of Oncology Practice.

“In this representative sample of Medicare patients with advanced cancer, we found patients who received palliative care experienced significantly less aggressive care, lower rates of hospitalization, increased use of hospice, and fewer invasive procedures near the end of life,” wrote Daniel P. Triplett, of the Moores Cancer Center at the University of California San Diego, and colleagues. “Given the increasing number of elderly patients with advanced cancer, the findings in this study emphasize the important role palliative care plays in global public health.”

The incorporation of palliative care in oncology has increased in the last decade, but there were few data on whether its use affected the aggressiveness of care at the end of life. This study looked at palliative care use at the end of life among 6,580 Medicare beneficiaries. Participants had either advanced prostate, breast, lung, or colorectal cancer. The researchers looked at health care utilization before and after palliative care consultation.

For the 30 days prior to palliative care consultation, the patients who received palliative care had increased use of many health care services, including higher rates of hospitalization (risk ratio [RR], 3.33), invasive procedures (RR, 1.75), and chemotherapy administration (RR, 1.61).

However, after receiving a palliative care consultation, health care utilization was significantly lower in these patients. Having received palliative care resulted in lower rates of hospitalization (RR, 0.53), invasive procedures (RR, 0.52), and chemotherapy administration (RR, 0.46). In addition, patients who received palliative care were 24% more likely to enroll in hospice.

“Essentially, we found palliative care represents an inflection point in patient care, with higher use of health care services before palliative care consultation and lower use after,” the researchers wrote. Receipt of palliative care consultation earlier in the course of the disease yielded a larger absolute reduction in health care use vs consultation closer to end of life. Click here to read the full story.

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