Inpatient and Outpatient Palliative Care Utilization Rates of Patients With Spine Metastases.

STUDY DESIGN: Retrospective review. OBJECTIVE: Specialty palliative care (PC) can be instrumental in improving patient quality of life for patients with spine metastasis. It is important to identify disparities in access to PC to ensure that equitable care is provided to all patients. No prior study has assessed the impact of sociodemographic and treatment factors on the utilization of in-patient (IPPC) and outpatient (OPPC) PCs in patients with spine metastases. MATERIALS AND METHODS: We examined IPPC and OPPC utilization in a cohort of 265 patients seen by our institution's Brain and Spine Metastases Tumor Board (BSMTB) between February 1, 2018 and February 31, 2020. Statistical analyses were performed comparing characteristics and outcomes between patients who did or did not utilize IPPC and/or OPPC. RESULTS: We observed no difference in rates of IPPC and OPPC consultation between patients across sex or race. Outpatient PC consultations varied across insurance and primary tumor type ( P = 0.056 and P = 0.025, respectively). Patients who received surgical intervention or radiation therapy within 30 days of being presented at BSMTB had higher rates of OPPC utilization than those who did not ( P = 0.0032 and P = 0.040, respectively). Patients who received an IPPC consult had worse overall survival than patients who did not consult IPPC (6.5 vs . 24.2 mo median survival), while those seen by OPPC had less of a survival disadvantage; median survival for OPPC was 11.2 months versus 19.2 months for those who were not seen by OPPC. CONCLUSION: We identified differences in PC utilization across insurance and primary tumor types. In addition, we present the unique finding that patients who receive surgery or RT for their spine metastases had higher rates of OPPC consultations than those who did not. Further work is needed to better appreciate PC utilization trends and identify interventions that improve the accessibility of PC.

Duke Scholars

Author Margaret Johnson Neurosurgery

Author Courtney Rory Goodwin Neurosurgery

Author James Emmett Herndon II Biostatistics & Bioinformatics, Division of Biostatistics

Author Christopher Jones Medicine, Geriatrics and Palliative Care