TY - JOUR
T1 - Temporal trends and social barriers for inpatient palliative care delivery in metastatic prostate cancer patients receiving critical care therapies
T2 - Prostate Cancer and Prostatic Diseases
AU - Mazzone, E.
AU - Mistretta, F.A.
AU - Knipper, S.
AU - Tian, Z.
AU - Palumbo, C.
AU - Gandaglia, G.
AU - Fossati, N.
AU - Shariat, S.F.
AU - Saad, F.
AU - Montorsi, F.
AU - Graefen, M.
AU - Briganti, A.
AU - Karakiewicz, P.I.
N1 - Cited By :2
Export Date: 11 March 2021
CODEN: PCPDF
Correspondence Address: Mazzone, E.; Cancer Prognostics and Health Outcomes Unit, Canada; email: eliomazzone@gmail.com
PY - 2020
Y1 - 2020
N2 - 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. © 2019, The Author(s), under exclusive licence to Springer Nature Limited.
AB - 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. © 2019, The Author(s), under exclusive licence to Springer Nature Limited.
KW - African American
KW - aged
KW - Article
KW - artificial ventilation
KW - Caucasian
KW - gastrointestinal disease
KW - health care delivery
KW - hospital admission
KW - hospital patient
KW - human
KW - intensive care
KW - major clinical study
KW - male
KW - metastasis
KW - palliative therapy
KW - parenteral nutrition
KW - percutaneous endoscopic gastrostomy
KW - priority journal
KW - prostate cancer
KW - teaching hospital
KW - trend study
KW - urogenital tract disease
U2 - 10.1038/s41391-019-0183-9
DO - 10.1038/s41391-019-0183-9
M3 - Article
VL - 23
SP - 260
EP - 268
JO - Prostate Cancer Prostatic Dis.
JF - Prostate Cancer Prostatic Dis.
SN - 1365-7852
IS - 2
ER -