Trends in Palliative Care Utilization in Patients with Bone Metastases

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Bone metastases significantly impact patient quality of life.
• Current palliative care (PC) utilization patterns in patients with bone metastases are not well understood.
• Effective strategies for integrating PC into oncology care are needed.

Purpose of the Study:

• To analyze trends in PC utilization for patients with bone metastases from 2011-2021.
• To compare inpatient palliative care (IPPC) and outpatient palliative care (OPPC) usage.
• To identify factors predicting PC engagement and its effect on hospital readmissions.

Main Methods:

• Retrospective analysis of 471,713 patients with bone metastases using the PearlDiver database (2011-2021).
• Classification of PC encounters into IPPC and OPPC.
• Statistical analysis using linear and multivariate logistic regression to assess trends, predictors, and outcomes.

Main Results:

• Only 17.2% of patients received PC; overall PC use showed no significant increase (p=0.14).
• Outpatient palliative care (OPPC) utilization increased from 0.7% to 2.6% (R²=0.87).
• Younger age, female gender, higher comorbidity, Medicaid insurance, and region predicted PC use. OPPC within six months of hospice was linked to 77% lower readmission odds (OR: 0.23, p<0.001).

Conclusions:

• Palliative care utilization remains suboptimal for patients with bone metastases.
• The rise in OPPC is associated with decreased hospital readmissions before hospice referral.
• Expanding OPPC services holds potential for reducing hospitalizations and enhancing care quality for this population.