OBJECTIVES: Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients. MATERIALS AND METHODS: We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined "early PC" if the patients received PC within 30 days of diagnosis. RESULTS: A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P<0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P=0.004) and lower total charges of ED care ($3158 vs. $3981, P<0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P=0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P=0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P=0.007) and lower charges of ED care (P=0.018) for all patients. CONCLUSIONS: Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.
OBJECTIVES: Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients. MATERIALS AND METHODS: We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined "early PC" if the patients received PC within 30 days of diagnosis. RESULTS: A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P<0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P=0.004) and lower total charges of ED care ($3158 vs. $3981, P<0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P=0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P=0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P=0.007) and lower charges of ED care (P=0.018) for all patients. CONCLUSIONS: Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.
Authors: Marieke Dingena Spreeuwenberg; Anna Bartak; Marcel A Croon; Jacques A Hagenaars; Jan J V Busschbach; Helene Andrea; Jos Twisk; Theo Stijnen Journal: Med Care Date: 2010-02 Impact factor: 2.983
Authors: Edward P Balaban; Pamela B Mangu; Alok A Khorana; Manish A Shah; Somnath Mukherjee; Christopher H Crane; Milind M Javle; Jennifer R Eads; Peter Allen; Andrew H Ko; Anitra Engebretson; Joseph M Herman; John H Strickler; Al B Benson; Susan Urba; Nelson S Yee Journal: J Clin Oncol Date: 2016-05-31 Impact factor: 44.544
Authors: Daniel P Triplett; Wendi G LeBrett; Alex K Bryant; Andrew R Bruggeman; Rayna K Matsuno; Lindsay Hwang; Isabel J Boero; Eric J Roeland; Heidi N Yeung; James D Murphy Journal: J Oncol Pract Date: 2017-08-22 Impact factor: 3.840
Authors: Nizar Bhulani; Arjun Gupta; Ang Gao; Jenny Li; Chad Guenther; Chul Ahn; Elizabeth Paulk; Stephanie Houck; Muhammad S Beg Journal: J Gastrointest Oncol Date: 2018-06