• Kelly C Vranas, Jodi A Lapidus, Linda Ganzini, Christopher G Slatore, and Donald R Sullivan.
• Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Health Services Research & Development, VA Portland Health Care System, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR. Electronic address: vranas@ohsu.edu.
• Chest. 2020 Dec 1; 158 (6): 266726742667-2674.

BackgroundPalliative care is associated with improved survival and quality of life among patients with lung cancer; however, its influence on health-care utilization and quality of care is unclear.Research QuestionIs palliative care, and the setting in which it occurs, associated with health-care resource utilization and quality of care among patients with advanced lung cancer?Study Design And MethodsThis was a retrospective cohort study of 23,142 patients with stage IIIB/IV lung cancer in the Veterans Affairs HealthCare System between 2007 and 2013. Exposures included the receipt of specialist-delivered palliative care, and the setting of the initial palliative care encounter (inpatient or outpatient) received after cancer diagnosis. Primary outcomes included rates of ED visits, along with rates of hospitalization and odds of ICU admission within the last 30 days of life. Secondary outcomes included any health-care utilization (ED, hospital, or ICU) related to chemotherapy toxicity. We used propensity score methods to perform Poisson and logistic regression modeling.ResultsAmong the 23,142 patients, 57% received palliative care, and 36% of initial palliative care encounters were outpatient. Compared with no palliative care, initial palliative care encounter in the outpatient setting was associated with reduced rates of ED visits (adjusted incidence rate ratio [aIRR], 0.86; 95% CI, 0.77-0.96) and hospitalizations in the last 30 days of life (aIRR, 0.64; 95% CI, 0.59-0.70). Initial palliative care encounters in both inpatient (adjusted OR [aOR], 0.63; 95% CI, 0.53-0.75) and outpatient (aOR, 0.42; 95% CI, 0.35-0.52) settings were associated with reduced odds of ICU admission in the last 30 days of life. Palliative care was also associated with reduced health-care utilization related to chemotherapy toxicity (aOR, 0.88; 95% CI, 0.82-0.95).InterpretationPalliative care (particularly in outpatient settings) is associated with reduced health-care utilization at the end of life and may improve the quality of care among patients with advanced lung cancer. These findings support the role of palliative care as an important component of comprehensive cancer care and highlight the potential benefits of outpatient palliative care services.Copyright © 2020 American College of Chest Physicians. All rights reserved.

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