Palliative Care Consultation and End-of-Life Care Among Patients With Esophageal Cancer and Inpatient Mortality

Palliative care (PC) is an important facet of treatment for patients with advanced esophageal cancer because of symptom burden, low overall 5-year survival rate, and significant impact on quality of life. This patient population experiences high hospitalization burden. The purpose of this study was to analyze the effect of PC on end-of-life (EoL) hospitalizations and evaluate racial differences in EoL care.

The National Inpatient Sample (NIS) was queried between 2016 and 2020 for hospitalizations with esophageal cancer that ended with inpatient death. The primary EoL outcomes that were identified include inpatient PC consultation (PCC), do not resuscitate (DNR) code status, and utilization of certain medical interventions (mechanical ventilation, blood transfusion, vasopressor administration, and chemotherapy). Secondary outcomes include symptom burden, length of stay (LOS), and total hospital charges.

Seventeen thousand seven hundred forty-five hospitalizations were included, of which 10,370 (58.4%) received PCCs and 7,375 (41.6%) did not. Age and sex were not significantly different between the patients who did and did not receive PCC. PCC cohort had a higher percentage of White patients (60.9% v 39.1%, P < .001). PCCs resulted in shorter LOS (7.5 v 8.9 days, P < .001), lower mean total hospital charges accumulated ($97,879 in US dollars [USD] v $146,128 [USD], P < .001), and higher rates of DNR code status (78.1% v 43.2%, P < .001). Inpatient PCC was also associated with lower rates of medical interventions (blood transfusions, mechanical ventilation, and chemotherapy). PCC was less likely to be performed among Black patients compared with White patients (adjusted odds ratio [aOR], 0.53 [95% CI, 0.48 to 0.58]). Black patients were also less likely to be DNR compared with White patients (aOR, 0.81 [95% CI, 0.74 to 0.90]).

PCCs at EoL were associated with higher rates of DNR and lower rates of medical interventions.