Recent research looking at palliative care patients in Canada has found higher hospital mortality rates among those without cancer compared to others. The trend reflects others taking shape in the United States.
The odds of dying in a hospital were 1.24 times higher among 1,822 patients without cancer who received palliative care services at an academic tertiary hospital in Toronto, Canada, from 2013 to 2019, according to a study published in Palliative Medicine. Researchers were from palliative medicine divisions at Sunnybrook Health Sciences Centre in Ontario and the University of Toronto.
The study examined outcomes of 6,846 palliative care patients at the hospital. The proportion of patients without cancer who passed away in a hospital setting was “substantially higher” compared to those without the disease, at 41.2% versus 14%, respectively, researchers indicated.
“Hospitalized patients without cancer were referred to specialist palliative care at a lower functional status, [had] a poorer anticipated prognosis, and [were] more likely for end-of-life care; and were more likely to die in hospital,” the researchers said.
Hospitalized palliative patients without cancer were more likely to be referred to additional services such as advance care planning, end-of-life care and psychosocial support, the study found. Patients with cancer were more often referred for pain and symptom management services.
More research is needed to determine ties between hospitalization rates and quality impacts among palliative care with and without cancer diagnoses, the research indicated.
“In-hospital mortality can serve as a quality indicator of acute care,” the researchers stated. “Patients with and without cancer are frequently hospitalized, and have specialist palliative care needs. Trends in acute care outcomes have not previously been evaluated in patients with confirmed specialist palliative care needs or between diagnostic groups. Future studies are required to determine whether a proportion of hospital deaths in patients without cancer represent goal-discordant end-of-life care.”
The study adds to a growing body of research digging into the impacts of palliative care experiences among cancer patients, both inside and outside of hospital settings.
Case in point, recent research has found that varying state laws around palliative care in the United States can impact cancer patients’ place of death.
Cancer patients in states with laws that require health care providers to provide palliative consultations were more likely to die in the home or in an inpatient hospice setting versus the hospital, a JAMA Network Open study found.
Clinicians’ misperceptions of the nature of palliative care services have cropped up as a main access and utilization issue impacting where and how patients receive serious illness support.
In 2022, an Oncology Insights report from Cardinal Health revealed that many specialists in the United States do not refer cancer patients to palliative care or mental health care during their course of treatment. Physicians in a survey of more than 240 oncologists cited a lack of understanding of palliative care as a leading barrier.
