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- Title
Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization.
- Authors
Milki, Anthony; Mann, Amandeep Kaur; Gardner, Austin; Kapp, Daniel Stuart; English, Diana; Chan, John K.
- Abstract
Objective: To determine factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. Methods: Data were abstracted from the National Inpatient Sample database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were used for statistical analyses. Results: Of 4559 women (median age: 65 years; range: 19-102), 1066 (23.4%) utilized PC. Patients were 24.9% low socioeconomic status (SES), 23.9% low-middle, 23.7% middle-high, and 25.1% high SES. Medicare, Medicaid, and private insurance coverage were listed at 46.2%, 37.5%, 11.3% of patients; 36.2%, 21.1%, 18.1%, 24.6% were treated in the South, West, Midwest, and Northeast. Over the 7 year study period, the use of PC increased from 12% to 45%. Older age (odds ratio [OR]: 1.36; 95% CI: 1.11-1.68; P =.003), high SES (OR: 1.41; 95% CI: 1.12-1.78; P =.003), more recent treatment (OR: 9.22; 95% CI: 6.8-12.51; P <.0001), private insurance (OR: 1.81; 95% CI: 1.46-2.25; P <.001), and treatment at large-volume hospitals (OR: 1.36; 95% CI: 1.04-1.77; P =.02), Western (OR: 2.00; 95% CI: 1.61-2.49; P <.001) and Midwestern hospitals (OR: 1.35; 95% CI: 1.08-1.68; P =.001) were associated with higher utilization of PC. Conclusions: The use of inpatient PC for patients with gynecologic cancer increased over time. The lower utilization of PC for terminal illness was associated with younger age, lower SES, government-issued insurance coverage, and treatment in Southern and smaller volume hospitals, and warrants further attention.
- Subjects
UNITED States; AGE distribution; CANCER patient psychology; CHI-squared test; CONFIDENCE intervals; FEMALE reproductive organ tumors; LENGTH of stay in hospitals; INSURANCE; LONGITUDINAL method; MEDICAID; MEDICAL care use; MEDICARE; METASTASIS; MULTIVARIATE analysis; OVARIAN tumors; PALLIATIVE treatment; POPULATION geography; UTERINE tumors; CERVIX uteri tumors; LOGISTIC regression analysis; PRIVATE sector; SOCIOECONOMIC factors; CROSS-sectional method; DATA analysis software; DESCRIPTIVE statistics; HOSPITAL mortality; ODDS ratio
- Publication
American Journal of Hospice & Palliative Medicine, 2021, Vol 38, Issue 2, p138
- ISSN
1049-9091
- Publication type
Article
- DOI
10.1177/1049909120935038