Timing of Palliative Care in Colorectal Cancer Patients: Does It Matter?

• Published in: The Journal of surgical research Vol. 241; pp. 285 - 293
• Main Authors: Delisle, Megan E., Ward, Mellissa A.R., Helewa, Ramzi M., Hochman, David, Park, Jason, McKay, Andrew
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2019
• Subjects: Aged; Aged, 80 and over; Canada - epidemiology; Colorectal cancer; Colorectal Neoplasms - economics; Colorectal Neoplasms - mortality; Colorectal Neoplasms - therapy; Cost-Benefit Analysis - statistics & numerical data; Delivery of Health Care, Integrated - economics; Delivery of Health Care, Integrated - methods; Delivery of Health Care, Integrated - statistics & numerical data; End-of-life care; Evidence-Based Medicine - economics; Evidence-Based Medicine - methods; Evidence-Based Medicine - statistics & numerical data; Female; Health care costs; Health Expenditures - statistics & numerical data; Hospital Mortality; Humans; Male; Medical Oncology - economics; Medical Oncology - methods; Medical Oncology - statistics & numerical data; Middle Aged; Palliative care; Palliative Care - economics; Palliative Care - methods; Palliative Care - statistics & numerical data; Patient Acceptance of Health Care - statistics & numerical data; Registries - statistics & numerical data; Retrospective Studies; Terminal Care - economics; Terminal Care - methods; Terminal Care - statistics & numerical data; Time Factors; Canada; Palliative care; Health care costs; End-of-life care; Colorectal cancer
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.04.009

Palliative care can improve end-of-life care and reduce health care expenditures, but the optimal timing for initiation remains unclear. We sought to characterize the association between timing of palliative care, in-hospital deaths, and health care costs.
This is a retrospective cohort study including all patients who were diagnosed and died of colorectal cancer between 2004 and 2012 in Manitoba, Canada. The primary exposure was timing of palliative care, defined as no involvement, late involvement (less than 14 d before death), early involvement (14 to 60 d before death), and very early involvement (>60 d before death). The primary outcome was in-hospital deaths and end-of-life health care costs.
A total of 1607 patients were included; 315 (20%) received palliative care and 162 (10%) died in hospital. Compared to those who did not receive palliative care, patients with early and very early involvement experienced significantly decreased odds of dying in hospital (OR 0.21 95% CI 0.06-0.69 P = 0.01 and OR 0.11 95% CI 0.01-0.78 P = 0.03, respectively) and significantly lower health care costs. There were no significant differences in in-hospital deaths and health care costs between patients without palliative care and those who received late palliative care.
Early palliative care involvement is associated with decreased odds of dying in hospital and lower health care utilization and costs in patients with colorectal cancer. These findings provide real-world evidence supporting early integration of palliative care, although the optimal timing (early versus very early) remains a matter of debate.