Abstract C004: End-of-life care in patients with advanced cancer in an urban safety net hospital

3 Background: Integration of palliative care early in treatment of malignancy improves quality of life and curbs non-beneficial end of life care. However, there are differences in utilization of palliative services based on cultural background. We aim to identify such differences in a safety net hospital with adiverse patient population. Methods: This is a single institution retrospective study of adults with cancer who had inpatient palliative care encounter (PCE) between 2012-2017. A representative sample of 130 patients from 7 major ethnicities was included. Statistical analysis was performed using STATA. Results: Only 8.4% of all patients had a preceding outpatient PCE. Very few patients had advance directives prior to PCE (range 0-30% for individual ethnicities). As a reflection of their challenging social situation, 5.3% were homeless, 76.1% lived in someone else’s home, <10% had English as primary language (except Caucasian American and African American.) Healthcare utilization in the last 3 months of life varied widely between groups- maximum was in African American and Hispanic patients with ≥3 emergency room visits in 30% and 25% respectively. Table with time to important endpoints and setting of death is attached. Conclusions: Palliative service was involved very late in care, with most having significant challenges to complex care discussions including lack of social support and language barrier. Setting of death (ICU versus home) varied by ethnicity, and some groups had high utilization of aggressive end of life care. Understanding the underlying cultural intricacies leading to these choices will help physicians better navigate care and should be a future focus of study. [Table: see text]

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Health care utilization and patient-related outcomes in patients with malignant bowel obstruction admitted to a United States safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.50 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 50-50

Author(s):

Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽

Aakash Putta ◽

Ishaan Vohra ◽

Vatsala Katiyar ◽

Krishna Moturi ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

End Of Life ◽

Surgical Management ◽

End Of Life Care ◽

Safety Net ◽

Care Utilization ◽

Life Care ◽

Malignant Bowel Obstruction ◽

Safety Net Hospital

50 Background: Malignant bowel obstruction (MBO) and gastric outlet obstruction (GOO) can be a late complication of intra-abdominal malignancy with a poor prognosis. Most studies about its outcomes have focused on survival. There is paucity of studies assessing health care utilization and end of life care decisions. Methods: We retrospectively collected data from the electronic medical record of patients admitted with MBO or GOO at a safety-net hospital in Chicago, US between January 2013 and December 2017. The charts were analyzed for outcomes related to end of life care and health care utilization. The outcomes were compared by across three broad treatment arms: those that received surgical intervention, those that received venting gastrostomy (VG) and those that were treated medically alone. Results: Forty-six patients were identified of which 31 were admitted with MBO. 25 (54%) of them were due to stage IV cancers. Mean age of study population was 61 years. Surgical management, VG and medical management were done in 17, 8 and 21 patients respectively. There was no difference in ICU admission rate, length of stay of index admission, 90 day-readmission rate or mean visits to the ER between the groups. Patients receiving venting gastrostomy tube had highest rate of oral solid food tolerability. Twenty-eight patients died or were enrolled in hospice within a median of 115 days. Conclusions: All modalities of treatment had similar health utilization measures in patients with MBO and GOO. Surgical management, if feasible, has the longest time to hospice enrollment or death and should be offered to patients who are suitable. [Table: see text]

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