Palliative care reduces emergency room visits and total hospital days among patients with metastatic HPB and GI cancers

Abstract Purpose: Palliative care services (PCS) have improved quality of life for patients across various cancer subtypes. Minimal data exists regarding the use of PCS for metastatic hepatopancreaticobiliary (HPB) and gastrointestinal (GI) malignancies. We assessed the impact of PCS on emergency department (ED) visits, hospital admissions, and survival among patients with these terminal malignancies.Methods: We identified all patients with metastatic HPB and GI malignancies referred to outpatient PCS for end-of-life care between 2014 and 2018. A subset of referred patients did not attend their appointment and did not receive PCS. We compared the demographics, outcomes, and end-of-life indicators between those who did and did not receive PCS. Results: 183 patients were referred for PCS. Most patients had metastatic colorectal (mCRC) (41%) or pancreatic (19.1%) cancers. 118 (64.5%) patients received PCS; 65 (35.5%) did not. No difference was noted in age, gender, race, marital status, or insurance coverage. Those receiving PCS were more likely to have mCRC (49.2% versus 26.2%, p = 0.0082) and were more likely to receive chemotherapy (80.5% versus 63.1%, p = 0.0098). On multivariate analysis, PCS was associated with fewer ED visits (p = 0.0319), hospital admissions (p = 0.0002), and total inpatient hospital days (p < 0.0001) per 30 days of life. Overall survival was greater among patients receiving PCS (HR = 0.65, 95% CI: 0.46-0.92).Conclusion: Outpatient PCS for patients with metastatic HPB and GI malignancies is associated with fewer ER visits, fewer hospital admissions, fewer inpatient hospital days, and improved overall survival.