Early palliative care in pancreatic cancer tied to fewer ED visits, lower hospital cost

Early referrals for palliative care (PC) among patients with pancreatic cancer result in reduced emergency department (ED) visits and ED-related charges, a study has shown.

“Most patients with pancreatic cancer have high symptom burden and poor outcomes,” the authors said. “PC can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood.”

In this study, the authors enrolled patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least one PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. They excluded those who had unknown follow-up. Early PC was defined as patients receiving PC within 30 days of diagnosis.

Of the 3,166 patients who had a PC encounter, 28 percent had an early PC. Patients receiving early PC were more likely to be female and at older age compared to those receiving late PC (p<0.001). Early PC recipients also had fewer ED visits (2.6 vs 3.0 visits; p=0.004) and lower total charges of ED care ($3,158 vs $3,981; p<0.001) than those who received late PC.

In addition, the early PC group had lower admissions to the intensive care unit (ICU; 0.82 vs 0.98 visits; p=0.006) and total charges of ICU care ($14,466 vs $18,687; p=0.01).

Multivariable analysis also revealed that early PC was significantly associated with fewer ED visits (p=0.007) and lower charges of ED care (p=0.018) for all patients.

“Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer,” the authors said.