In the Journals

Palliative care reduces financial burden of patients with advanced cancer, comorbidities

The immediate initiation of palliative care among hospitalized patients with incurable cancers and chronic comorbid conditions resulted in significant hospital cost savings, according to research published in Health Affairs.

“We already know that coordinated, patient-centered palliative care improves care quality, enhances survival and reduces costs for persons with cancer,” R. Sean Morrison, MD, director of the National Palliative Care Research Center and professor of geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine, said in a press release. “Among patients with advanced cancer and other serious illnesses, aggressive treatments are often inconsistent with patients’ wishes and are associated with worse quality of life compared with other treatments. It is imperative that policymakers act to expand access to palliative care."

Morrison and colleagues sought to determine the financial implications of palliative care vs. usual care in hospitalized patients with advanced cancers. They recruited patients with advanced cancer and collected clinical and hospital cost data from six U.S. treatment centers for a prospective, observational study.

Patients seen by a palliative care consultation team while hospitalized comprised the treatment group (n = 193), whereas patients who received usual care served as comparisons (n = 713). Patients in both groups had similar mean Elixhauser comorbidity scores (3.3 vs. 3.4).

The researchers observed that consultation with a palliative care team within 2 days of hospitalization appeared associated with a significant reduction in hospital costs. Further, they reported that the effect size increased with the number of patient comorbidities.

Patients with advanced cancer and a comorbidity score of 2 or 3 experienced a 22% reduction in hospital costs (estimated reduction = $2,321). Among patients with a comorbidity score of 4 or greater, the reduction percentage increased to 32% (estimated reduction = $3,515).

The estimated mean treatment effect did not appear significant among patients with a comorbidity score of 0 to 1.

The researchers acknowledged limitations of their study. They noted that patients who received palliative consultations may have already been inclined to select less aggressive — and thus, less expensive — treatment options. They further acknowledged that selection bias may have led to the exclusion of very ill patients, as participation in the study was incumbent upon the patients’ ability to participate during their hospitalization.

The analysis also did not include professional fees or costs associated with post-acute care.

“The fact that we found greater cost savings for patients with cancer with more comorbidities than for those with fewer comorbidities raises the question of whether similar results would be observed in patients with other serious illnesses and multimorbidity,” Peter May, health economics of cancer fellow at Trinity College Dublin and visiting research fellow in geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine, said in a press release. “Future research is also needed to determine when in the course of illness palliative care is most cost-effective.” – by Cameron Kelsall

Disclosure: May reports grant support from the Health Research Board of Ireland and the NCI. Morrison reports a research award from the NIH. Please see the full study for a list of all other researchers’ relevant financial disclosures.

The immediate initiation of palliative care among hospitalized patients with incurable cancers and chronic comorbid conditions resulted in significant hospital cost savings, according to research published in Health Affairs.

“We already know that coordinated, patient-centered palliative care improves care quality, enhances survival and reduces costs for persons with cancer,” R. Sean Morrison, MD, director of the National Palliative Care Research Center and professor of geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine, said in a press release. “Among patients with advanced cancer and other serious illnesses, aggressive treatments are often inconsistent with patients’ wishes and are associated with worse quality of life compared with other treatments. It is imperative that policymakers act to expand access to palliative care."

Morrison and colleagues sought to determine the financial implications of palliative care vs. usual care in hospitalized patients with advanced cancers. They recruited patients with advanced cancer and collected clinical and hospital cost data from six U.S. treatment centers for a prospective, observational study.

Patients seen by a palliative care consultation team while hospitalized comprised the treatment group (n = 193), whereas patients who received usual care served as comparisons (n = 713). Patients in both groups had similar mean Elixhauser comorbidity scores (3.3 vs. 3.4).

The researchers observed that consultation with a palliative care team within 2 days of hospitalization appeared associated with a significant reduction in hospital costs. Further, they reported that the effect size increased with the number of patient comorbidities.

Patients with advanced cancer and a comorbidity score of 2 or 3 experienced a 22% reduction in hospital costs (estimated reduction = $2,321). Among patients with a comorbidity score of 4 or greater, the reduction percentage increased to 32% (estimated reduction = $3,515).

The estimated mean treatment effect did not appear significant among patients with a comorbidity score of 0 to 1.

The researchers acknowledged limitations of their study. They noted that patients who received palliative consultations may have already been inclined to select less aggressive — and thus, less expensive — treatment options. They further acknowledged that selection bias may have led to the exclusion of very ill patients, as participation in the study was incumbent upon the patients’ ability to participate during their hospitalization.

The analysis also did not include professional fees or costs associated with post-acute care.

“The fact that we found greater cost savings for patients with cancer with more comorbidities than for those with fewer comorbidities raises the question of whether similar results would be observed in patients with other serious illnesses and multimorbidity,” Peter May, health economics of cancer fellow at Trinity College Dublin and visiting research fellow in geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine, said in a press release. “Future research is also needed to determine when in the course of illness palliative care is most cost-effective.” – by Cameron Kelsall

Disclosure: May reports grant support from the Health Research Board of Ireland and the NCI. Morrison reports a research award from the NIH. Please see the full study for a list of all other researchers’ relevant financial disclosures.