Impact of Frailty on Palliative Care Setting in Patients with Advanced Cancer in a Safety-Net System

Frailty is common among patients with advanced cancer and increases risk for poorer outcomes. Frail patients may benefit from palliative care (PC) services. Limited data examine how frailty relates to PC delivery within safety-net systems.

To examine association between frailty and setting of PC initiation (inpatient consultation vs outpatient clinic referral) among patients with advanced cancer. Secondarily, we examined whether frailty was associated with PC exposure exclusively in the inpatient setting vs only outpatient referral.

Patients with advanced-stage solid tumor exposed to PC from January 2018 to July 2023 at Parkland Health were identified via electronic health record. Multivariate logistic regression examined associations between frailty level, using a modified electronic frailty index, and 1) initial PC exposure as inpatient consultation (vs outpatient referral) and 2) inpatient consultation-only (vs outpatient referral-only). Models adjusted for key covariates.

Among 1,053 patients (44.3% female, 75% non-White, mean age: 57.7), 46.2% were mildly frail and 23.6% were moderately/severely frail. In multivariate regression, frailty was associated with greater odds of initiating PC as an inpatient consultation (v fit; moderate/severe frailty: adjusted Odds Ratio (aOR), 3.50 [95% CI 1.71 to 7.18]; mild frailty: aOR, 2.37 [95% CI 1.34 to 4.19]) and inpatient consultation-only (v fit; moderate/severe frailty: aOR 4.48, [95% CI 2.67 to 7.53]; mild frailty: (aOR 2.72, [95% CI 1.74 to 4.24]).

Higher frailty was associated with inpatient PC initiation among patients with advanced cancer exposed to PC. These findings reflect the complex interplay of increased disease burden and access challenges faced by vulnerable cancer patients.