Temporal Trends and Barriers for Inpatient Palliative Care Referral in Metastatic Gynecologic Cancer Patients Receiving Specific Critical Care Therapies

Purpose: Existing evidence suggests that palliative care (PC) is highly underutilized in metastatic gynecologic cancer (mGCa). This study aims to explore temporal trends and predictors for inpatient PC referral in mGCa patients who received specific critical care therapies (CCT). Methods: : The National Inpatient Sample from 2003 to 2015 was used to identify mGCa patients receiving CCT. Basic characteristics between patients with and without PC were compared. Annual percentage change (APC) was estimated to reflect the temporal trend in entire cohort and subgroups. Multivariable logistic regression was employed to explore potential predictors of inpatient PC referral. Results: : In total, 10,380 mGCa patients receiving CCT were identified, among which 1208 (11.64%) received inpatient PC. Overall, rate of PC referral increased from 1.81% in 2003 to 26.30% in 2015 (APC: 29.08%). Higher increase in PC use was found in White (APC: 30.81%), medium bedsize hospitals (APC: 31.43%), Midwest (APC: 33.84%) and ovarian cancer (APC: 31.35%). Multivariable analysis suggested that medium bedsize, large bedsize, Midwest region, West region, uterine cancer and cervical cancer were related to increased PC use, while metastatic sites from lymph nodes and genital organs were related to lower PC referral. Conclusion: Although PC referral has increased over time, the absolute rate remains low. PC referral in mGCa patients receiving CCT varies among sociodemographic and clinical factors. Further efforts are warranted to better characterize the specific barriers and optimize end-of-life care for mGCa patients receiving CCT, especially for those diagnosed with ovarian cancer or admitted to small scale and Northeast hospitals.