Temporal Trends and Differences in Inpatient Palliative Care Use in Metastatic Penile Cancer Patients

Objectives: To quantify inpatient palliative care use over time and to test whether patient or hospital characteristics represent determinants of inpatient palliative care use in patients with metastatic penile cancer. Methods: Relying on the National Inpatient Sample database (2006-2019), we identified 1017 metastatic penile cancer patients. Estimated annual percentage change analyses and multivariable logistic regression models addressing inpatient palliative care use were fitted. Results: Of 1017 metastatic penile cancer patients, 139 (13.7%) received inpatient palliative care. Over time, the proportion of inpatient palliative care use per year increased from 6.5% in 2006 to 17.8% in 2019 (estimated annual percentage change +6.7%; p = 0.001). In the multivariable logistic regression models, contemporary study years (odds ratio [OR] 1.80; p = 0.003), the presence of bone metastases (OR 1.90; p = 0.002) and the presence of brain metastases (OR 2.60; p = 0.013) independently predicted higher inpatient palliative care use. Conversely, distant lymph node metastases independently predicted lower inpatient palliative care use (OR 0.58; p = 0.022). Finally, hospital admission in the South (OR 2.42; p = 0.007) and in the Northeast (OR 2.34; p = 0.015) was associated with higher inpatient palliative care use than hospital admission in the Midwest. Conclusions: In metastatic penile cancer patients, the proportions of inpatient palliative care use were low but have increased over time. Unfortunately, some geographical regions are more refractory to inpatient palliative care use than others. Finally, specific patient characteristics such as bone metastases and brain metastases represent independent predictors of higher inpatient palliative care use.