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Temporal trends and social barriers for inpatient palliative care delivery in metastatic prostate cancer patients receiving critical care therapies

Prostate Cancer and Prostatic Diseases volume 23, pages 260–268 (2020)Cite this article

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Abstract

Background

Use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. A recent analysis demonstrated that genitourinary (GU) cancer patients benefited of IPC at the second lowest rate within the four examined primaries, namely lung, breast, colorectal, and GU. Based on this observation, we examined temporal trends and predictors of IPC use in metastatic prostate cancer patients receiving critical care therapies (CCT).

Materials and methods

We identified mPCa patients receiving CCT within the Nationwide Inpatient Sample database (2004–2015). IPC use rates were evaluated using univariable estimated annual percentage changes analyses. Multivariable logistic regression (MLR) models were used after adjustment for clustering at hospital level.

Results

Of 4168 mPCa patients receiving CCT, 449 (11.3%) received IPC. IPC use increased from 1.2 to 22.3% (EAPC: +19.6%, p < 0.001). After stratification according to regions, race, and teaching status, the highest increase of IPC use was recorded in the South (from 0 to 25.4 %, EAPC: +27.6%), in Caucasians (from 1.5 to 24.4 %, EAPC: +19.8%; p < 0.001) and in teaching hospitals (from 0.9 to 26.2 %, EAPC: +19.6%; p < 0.001). In MLR models, teaching status (Odds ratio [OR]: 1.74, p < 0.001) and contemporary year interval (OR: 4.63, p < 0.001) were associated with higher IPC rates. Conversely, African American race (OR: 0.66, p < 0.001) and primary diagnosis of GU disorders (OR: 0.49, p < 0.001) and gastrointestinal (GI) disorders at admission (OR: 0.61, p = 0.02) were associated with lower IPC rates.

Conclusions

IPC use rate in mPCa patients receiving CCT sharply increased between 2004 and 2015. The highest increase of IPC use across time was recorded in the South, in Caucasian race, and in teaching hospitals. African-American race and nonteaching status were identified as independent predictors of lower IPC use and represent targets for efforts aimed at improving IPC delivery in mPCa patients receiving CCT.

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Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Elio Mazzone, Francesco A. Mistretta, Sophie Knipper, Zhe Tian, Carlotta Palumbo, Fred Saad & Pierre I. Karakiewicz

  2. Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy

    Elio Mazzone, Giorgio Gandaglia, Nicola Fossati, Francesco Montorsi & Alberto Briganti

  3. Vita-Salute San Raffaele University, Milan, Italy

    Elio Mazzone, Giorgio Gandaglia, Nicola Fossati, Francesco Montorsi & Alberto Briganti

  4. Department of Urology, European Institute of Oncology, Milan, Italy

    Francesco A. Mistretta

  5. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Sophie Knipper & Markus Graefen

  6. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy

    Carlotta Palumbo

  7. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  8. Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada

    Fred Saad & Pierre I. Karakiewicz

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  1. Elio Mazzone
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Elio Mazzone had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Elio Mazzone.

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Mazzone, E., Mistretta, F.A., Knipper, S. et al. Temporal trends and social barriers for inpatient palliative care delivery in metastatic prostate cancer patients receiving critical care therapies. Prostate Cancer Prostatic Dis 23, 260–268 (2020). https://doi.org/10.1038/s41391-019-0183-9

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