Elio Mazzone1,2,3, Francesco A Mistretta4,5, Sophie Knipper4,6, Zhe Tian4, Carlotta Palumbo4,7, Giorgio Gandaglia8,9, Nicola Fossati8,9, Shahrokh F Shariat10, Fred Saad4,11, Francesco Montorsi8,9, Markus Graefen6, Alberto Briganti8,9, Pierre I Karakiewicz4,11. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. eliomazzone@gmail.com. 2. Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy. eliomazzone@gmail.com. 3. Vita-Salute San Raffaele University, Milan, Italy. eliomazzone@gmail.com. 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. 5. Department of Urology, European Institute of Oncology, Milan, Italy. 6. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. 8. Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy. 9. Vita-Salute San Raffaele University, Milan, Italy. 10. Department of Urology, Medical University of Vienna, Vienna, Austria. 11. Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada.
Abstract
BACKGROUND: Use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. A recent analysis demonstrated that genitourinary (GU) cancer patients benefited of IPC at the second lowest rate within the four examined primaries, namely lung, breast, colorectal, and GU. Based on this observation, we examined temporal trends and predictors of IPC use in metastatic prostate cancer patients receiving critical care therapies (CCT). MATERIALS AND METHODS: We identified mPCa patients receiving CCT within the Nationwide Inpatient Sample database (2004-2015). IPC use rates were evaluated using univariable estimated annual percentage changes analyses. Multivariable logistic regression (MLR) models were used after adjustment for clustering at hospital level. RESULTS: Of 4168 mPCa patients receiving CCT, 449 (11.3%) received IPC. IPC use increased from 1.2 to 22.3% (EAPC: +19.6%, p < 0.001). After stratification according to regions, race, and teaching status, the highest increase of IPC use was recorded in the South (from 0 to 25.4 %, EAPC: +27.6%), in Caucasians (from 1.5 to 24.4 %, EAPC: +19.8%; p < 0.001) and in teaching hospitals (from 0.9 to 26.2 %, EAPC: +19.6%; p < 0.001). In MLR models, teaching status (Odds ratio [OR]: 1.74, p < 0.001) and contemporary year interval (OR: 4.63, p < 0.001) were associated with higher IPC rates. Conversely, African American race (OR: 0.66, p < 0.001) and primary diagnosis of GU disorders (OR: 0.49, p < 0.001) and gastrointestinal (GI) disorders at admission (OR: 0.61, p = 0.02) were associated with lower IPC rates. CONCLUSIONS: IPC use rate in mPCa patients receiving CCT sharply increased between 2004 and 2015. The highest increase of IPC use across time was recorded in the South, in Caucasian race, and in teaching hospitals. African-American race and nonteaching status were identified as independent predictors of lower IPC use and represent targets for efforts aimed at improving IPC delivery in mPCa patients receiving CCT.
BACKGROUND: Use of inpatient palliative care (IPC) in advanced cancerpatients represents a well-established guideline recommendation. A recent analysis demonstrated that genitourinary (GU) cancerpatients benefited of IPC at the second lowest rate within the four examined primaries, namely lung, breast, colorectal, and GU. Based on this observation, we examined temporal trends and predictors of IPC use in metastatic prostate cancerpatients receiving critical care therapies (CCT). MATERIALS AND METHODS: We identified mPCa patients receiving CCT within the Nationwide Inpatient Sample database (2004-2015). IPC use rates were evaluated using univariable estimated annual percentage changes analyses. Multivariable logistic regression (MLR) models were used after adjustment for clustering at hospital level. RESULTS: Of 4168 mPCa patients receiving CCT, 449 (11.3%) received IPC. IPC use increased from 1.2 to 22.3% (EAPC: +19.6%, p < 0.001). After stratification according to regions, race, and teaching status, the highest increase of IPC use was recorded in the South (from 0 to 25.4 %, EAPC: +27.6%), in Caucasians (from 1.5 to 24.4 %, EAPC: +19.8%; p < 0.001) and in teaching hospitals (from 0.9 to 26.2 %, EAPC: +19.6%; p < 0.001). In MLR models, teaching status (Odds ratio [OR]: 1.74, p < 0.001) and contemporary year interval (OR: 4.63, p < 0.001) were associated with higher IPC rates. Conversely, African American race (OR: 0.66, p < 0.001) and primary diagnosis of GU disorders (OR: 0.49, p < 0.001) and gastrointestinal (GI) disorders at admission (OR: 0.61, p = 0.02) were associated with lower IPC rates. CONCLUSIONS: IPC use rate in mPCa patients receiving CCT sharply increased between 2004 and 2015. The highest increase of IPC use across time was recorded in the South, in Caucasian race, and in teaching hospitals. African-American race and nonteaching status were identified as independent predictors of lower IPC use and represent targets for efforts aimed at improving IPC delivery in mPCa patients receiving CCT.