Inpatient palliative care utilisation among patients with gallbladder cancer in the United States: A 10-year perspective.

OBJECTIVES: Gallbladder cancer (GBC) is a rare, poor-prognosis cancer with unique demographics, comorbidities and a paucity of research. This study investigated inpatient palliative care and its associations with demographics, comorbidities (e.g., obesity), length of stay and hospital charges in GBC in US hospitals (2007-2016). METHODS: Data were extracted from the National Inpatient Sample (NIS) database that contains deidentified clinical and nonclinical information for each hospitalisation. Inpatient palliative care utilisation was identified using the International Classification of Diseases (ICD-9 and ICD-10) codes (V66.7 and Z51.5). Generalised regression analysis was conducted with adjustment for variations in predictors. RESULTS: Of the 4921 reported GBC hospitalizations, only 10.3% encountered palliative care. Palliative care was associated with reduced hospital charges by $12,405 per hospitalisation (P < 0.0001) with no change in length of stay. Palliative care utilisation increased over time (P = 0.004). It was associated with age >80 years, with more severe disease, and in-hospital death (P < 0.0001). Obesity had a negative association with palliative care utilisation (P = 0.0029). DISCUSSION: Our novel study found that obese people were less likely to use palliative care services in GBC. Interventions are needed to increase palliative care consultation in GBC patients, particularly in obese patients.

Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective.

Background-Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives-To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical characteristics, hospital charges, and LOS. Methods-De-identified patient data of each hospitalization were retrieved from the National Inpatient Sample (NIS) database. Codes V66.7 (ICD-9-CM) or Z51.5 (ICD-10-CM) were used to find palliative care utilization. Multivariate adjusted logistic regression analyses were conducted to assess factors associated with palliative care use, LOS, hospital charges, and in-hospital death. Results-Of 4426 hospitalizations, only 6.7% received palliative care services. Palliative care utilization did not significantly increase over time (p = 0.06); it reduced hospital charges by USD 25,937 (p < 0.0001) and LOS by 1.3 days (p = 0.0004) per hospitalization. Palliative care was positively associated with female gender, severe disease, and age group ≥80 (p ≤ 0.05). The average LOS was 8.5 days for each admission. Conclusions-Hospital admissions with palliative care utilization had lower hospital charges and LOS in ECC. However, ECC patients received less palliative care compared with more common cancers sharing similar symptoms (e.g., pancreatic cancer). ECC patients also had longer LOS compared with the national average. Further research is warranted to develop interventions to increase palliative care utilization among ECC hospital patients.