Trends in Palliative Care Utilization in Patients with Bone Metastases

Bone metastases cause significant symptom burden, yet patterns of palliative care (PC) utilization in this population remain poorly characterized.

To evaluate trends in PC use, compare inpatient palliative care (IPPC) and outpatient palliative care (OPPC) utilization, identify predictors of PC engagement, and assess the impact on readmissions.

Using the PearlDiver database (2011-2021), patients with bone metastases were identified. PC encounters were classified as IPPC or OPPC. Trends were assessed with linear regression; predictors and outcomes were evaluated using multivariate logistic regression.

Of 471,713 patients, 17.2% received PC. Overall PC use did not increase significantly from 2011 to 2021 (p = 0.14), though OPPC rose from 0.7% to 2.6% (R² = 0.87). Predictors of PC use included younger age (mean age 64 vs. 66 years, p < 0.001), female gender, higher comorbidity burden, Medicaid insurance, and region (p < 0.01 for all). Receipt of OPPC within six months of hospice was associated with 77% lower odds of readmission (Odds Ratio (OR): 0.23, 95% Confidence Interval (CI): 0.17-0.30, p < 0.001).

PC utilization remains low in this population. OPPC use has modestly increased and is associated with reduced readmissions prior to hospice referral. Expanding OPPC may reduce hospitalizations and improve care quality.