• Emily B Rosenfeld, John K Chan, Austin B Gardner, Natasha Curry, Lejla Delic, and Daniel S Kapp.
• 1 Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, Sutter Research Institute, San Francisco, CA, USA.
• Am J Hosp Palliat Care. 2018 Apr 1; 35 (4): 697-703.

ObjectiveTo determine the factors associated with inpatient palliative care (PC) use in patients with metastatic gynecologic cancer.MethodsData were obtained from the Nationwide Inpatient Sample (NIS) for patients with metastatic cervical, uterine, and ovarian cancers. Chi-square and multivariate models were used for statistical analyses.ResultsOf 67 947 inpatients with metastatic gynecologic cancer, 3337 (5%) utilized PC (median age: 63 years, range: 18-102 years). For the entire cohort, the majority was white (59%) and the remainder was black (10%), Hispanic (8%), and Asian (3%). Sixty-one percent had ovarian, 25% uterine, and 14% cervical cancers. Forty-four percent had Medicare, 37% private insurance, 12% Medicaid, and 3% were uninsured. Fifty-three percent of patients were treated at teaching hospitals, while 33% were treated at nonteaching hospitals. In multivariate analysis, the use of PC was associated with older age (≥63, median; odds ratio [OR] = 1.52, 95% confidence interval [CI]: 1.36-1.70; P < .0001) and black race (OR = 1.22, CI: 1.08-1.39; P < .01). Compared to patients with ovarian cancer, patients with uterine (OR = 1.63, CI: 1.46-1.83; P < .0001) and cervical (OR = 1.14, CI: 1.104-1.25; P < .01) cancer had higher rates of PC utilization. The proportion of patients receiving PC increased from 2% in 2005 to 10% in 2011. In a subset analysis of the 4517 patients who died during hospitalization, only 1056 (23%) patients received PC.ConclusionPatients who were older, black, or had uterine and cervical cancers were more likely to use PC. Although the overall use of PC has increased, less than one-quarter of patients who died in the hospital used PC services during their final hospital admission.

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