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Variation in Palliative Care Program Performance for Patients With Metastatic Cancer
May Hua1, Ling Guo2, Caleb Ing1
1Department of Anesthesiology (M.H., C.I.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Journal of Pain and Symptom Management
|October 24, 2024
Summary
Palliative care programs show significant variation in end-of-life care quality for advanced cancer patients, particularly in hospice use. Further research is needed to understand these differences and their impact on care quality.
Area of Science:
- Oncology
- Palliative Care
- Health Services Research
Background:
- Specialist palliative care improves end-of-life care for advanced cancer patients.
- However, its effectiveness can vary significantly across different hospitals.
Purpose of the Study:
- To investigate the variations in palliative care program performance regarding end-of-life care quality metrics.
- To quantify differences in program outcomes for patients with metastatic cancer.
Main Methods:
- Retrospective cohort study using the National Palliative Care Registry (2018-2019).
- Analyzed Medicare data for patients aged 65+ who died with metastatic cancer.
- Quantified variation using risk-standardized outcome rates (RSOR) and adjusted median odds ratios (aMOR).
Main Results:
- Substantial variation observed in hospice use (median RSOR 65.6%) and hospice enrollment of 3+ days (median RSOR 53.6%).
- Significant variation also found in intensive care use (median RSOR 14.1%), but not in chemotherapy use (median RSOR 1.5%).
- Hospice use showed the greatest variation (aMOR 1.48), indicating a 48% higher likelihood of hospice use in high-use programs.
Conclusions:
- Significant variation exists in end-of-life quality metrics for patients with metastatic cancer across palliative care programs.
- Further investigation is required to understand the reasons behind these variations.
- It is crucial to determine if these variations reflect differences in the quality of care provided.
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