A population-based, propensity-score matched, cohort study demonstrated that cancer decedents who received early palliative care reduced the median overall health system costs in the last month of life compared with those who had not received early palliative care.
The findings were presented by Hsien Seow, PhD, of McMaster University in Ontario, Canada, at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
“As you know there have been several trials that have shown the benefits of early palliative care so much so that ASCO has made guidelines about the concurrent introduction of palliative care in standard treatment,” said Dr Seow.
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However, few studies have assessed the impact of early vs late palliative care on end-of-life health services costs. Thus, Dr Seow and colleagues aimed to assess the impact of early palliative care, defined as 12 to 6 months before death, vs not-early palliative care among cancer decedents on health care costs (in the hospital or community) in the last 30 days of life.
The investigators created a large retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, and identified patients who received early palliative care. A control group of patients who received not-early palliative care (within 6 months of death or never) were hard matched on age, sex, cancer type, and stage and matched on additional characteristics (such as region, year, treatment, etc.) using statistical techniques. The team evaluated differences in average costs, including hospital, emergency department (ED), physician, and home care costs, between matched pairs in the last month of life.
Overall, 144,306 cancer decedents were identified, of whom 37% received early palliative care. After matching, there were 36,238 pairs of decedents who received early and not-early palliative care, and the early and not-early groups had equal distributions of age (mean, 69.4 years), sex (male, 51%), cancer types (breast, 11%; colorectal, 15%; lung, 24%; prostate, 8%) and stage (I-IV ranging from 3% to 14%; unavailable, 68%).
Relative to the control group, patients who received early palliative care used hospital inpatient care and the ED less frequently (66% vs 56% and 52% vs 42%, respectively) and used home care more often (63% vs 74%). When comparing total costs, those who received early palliative care spent approximately $1394 less in the last month of life compared with the control group ($12,752 vs $14,146; P <.001). These cost savings were largely attributable to the difference in inpatient hospital costs between the early and not-early palliative care groups (mean, $7105 vs $9370; P <.001).
“In conclusion, this is real world evidence of the cost savings of early palliative care. It doesn’t have to start at diagnosis, even 6 months before [death], there is huge cost savings and especially at a population level,” concluded Dr Seow.
Disclosures: This research was supported by Canadian Centre for Applied Research in Cancer Control (ARCC). Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see to the original reference for a full list of authors’ disclosures.
Reference
Seow H, Sutradhar R, Barbera LC, et al. Does early palliative care reduce end-of-life hospital costs? A propensity-score matched, population-based, cohort study. Presented at: ASCO21 Virtual Scientific Program. J Clin Oncol. 2021;39(suppl 15; abstr 12006). doi:10.1200/JCO.2021.39.15_suppl.12006
This article originally appeared on Oncology Nurse Advisor
