• Michael Bonares, Kalli Stilos, Madison Peters, Lise Huynh, and Debbie Selby.
• Division of Palliative Medicine (M.B., K.S., M.P., L.H., D.S.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Palliative Medicine (M.B., D.S.), Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute (M.B.), Toronto, ON, Canada. Electronic address: michael.bonares@mail.utoronto.ca.
• J Pain Symptom Manage. 2024 Nov 1; 68 (5): e373e381e373-e381.

ContextPeople with noncancer diagnoses have poorer access to palliative care units (PCUs) or hospices compared to those with cancer diagnoses. The COVID-19 pandemic disrupted how specialist palliative care services were delivered and utilized.ObjectiveTo determine the association between the start of the COVID-19 pandemic and PCU/hospice utilization in hospitalized individuals with cancer and noncancer diagnoses with specialist palliative care needs.MethodsRetrospective cohort study using routinely collected data. Percentages of individuals experiencing each disposition from hospital, including discharge to PCU/hospice, were calculated monthly for the total, cancer, and noncancer cohorts and were analyzed descriptively. Hospitalized individuals with specialist palliative care needs at a single academic hospital in Toronto, Canada from January 1, 2017, to September 31, 2022 (pandemic start was defined as April 1, 2020).ResultsThe cohort comprised 4349 individuals (median age=78 years; 52.4% female); 3065 (70.5%) and 1284 (29.5%) had cancer and noncancer diagnoses, respectively. Among individuals with noncancer diagnoses, the most significant absolute changes were a 13.0%-decrease in in-hospital deaths (prepandemic=49.6%; postpandemic=36.6%) and a 11.6%-increase in discharges to PCU/hospice (prepandemic=35.6%; postpandemic=47.3%). Among individuals with cancer, the most significant absolute changes were a 12.8%-increase in discharges home with formal care (prepandemic=2.3%; postpandemic=15.1%) and a 7.0%-decrease in in-hospital deaths (prepandemic=29.1%; postpandemic=22.0%).ConclusionDespite historically poor PCU/hospice access, the COVID-19 pandemic created circumstances that may have enabled unprecedented utilization in individuals with noncancer diagnoses in our cohort.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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