Palliative Care Utilization and Its Outcomes in Bone Metastasis Patients

Introduction: Bone metastases, a common complication of advanced cancer, frequently lead to significant psychological distress. Specialty palliative care (PC) can address these needs but remains underutilized. This study aims to describe trends in PC utilization, compare inpatient (IPPC) and outpatient (OPPC) palliative care, identify sociodemographic factors influencing PC use, and assess PC's impact on clinical outcomes.

Methods: A retrospective review of the PearlDiver database identified patients with bone metastases from 2011 to 2021. Demographic and clinical data were collected, and PC interactions were categorized as IPPC or OPPC. Patients transitioning to hospice during the study period was also identified as its own cohort. Linear regression assessed trends in PC use, while multivariable logistic regression identified predictors of utilization.

Results: Among 471,713 patients with bone metastases, 17.2% received PC. Overall PC utilization did not significantly increase over the study period. Age, gender, income, region, and insurance status were significant predictors of PC use. OPPC rates increased from 0.7% in 2011 to 2.6% in 2021 (R² = 0.87), while IPPC rates showed no clear trend (R² = 0.02). In the last six months of hospice, PC use rose significantly (p < 0.05). Patients receiving OPPC prior to hospice had lower readmission rates than those receiving IPPC (31.7% vs. 66.8%, p < 0.001), with OPPC linked to a 77% decrease in odds of readmission (OR: 0.23, 95% CI: 0.17-0.30; p < 0.001).

Conclusion : Despite a modest rise in the use of palliative care (PC) over the past decade, outpatient palliative care (OPPC) remains underutilized. OPPC is linked to lower hospital readmission rates compared to inpatient palliative care (IPPC), underscoring its potential advantages. Enhancing education on the early integration of palliative care could boost its utilization and improve care for patients with bone metastases.