Palliative Care Patients Without Cancer Have Higher Hospital Mortality Rates

Palliative care patients without cancer have higher hospital mortality rates, a lower functional status, and poorer prognosis than patients with cancer, according to a study published in Palliative Medicine.

Researchers conducted a retrospective cohort study of patients who received specialist palliative care at an academic tertiary hospital in Toronto, Canada, from January 1, 2013, to December 31, 2019, comparing trends in discharge location between hospitalized palliative care patients with and without cancer. A total of 6846 patients were included in the study, and 3578 were women. Of these, 5024 had a primary cancer diagnosis, and 1822 had a primary noncancer diagnosis. The median age was 80 years overall, with a median age of 92 for those without cancer and 75 for those with cancer. 

Among the palliative care patients who did not have cancer, 78.1% had a Palliative Performance Scale (PPS) score of less than 30%, while only 26.7% of patients with cancer had such a score. Additionally, 63.2% of patients without cancer had an anticipated prognosis of less than 1 month, and 19.2% of patients with cancer had this prognosis. A higher proportion of palliative care patients without cancer were referred for decision-making, discharge planning, end-of-life care, and psychosocial support. Patients with cancer were more likely to be referred for pain and symptom management. 

A total of 42% of palliative care patients without cancer died in the hospital, compared with 16.3% of patients with cancer. The proportion of patients without cancer who died in the hospital decreased by 8.4% from 2013 to 2019, but this proportion remained higher compared with patients with cancer at 14.0% and 41.2% in patients without cancer in 2019. 

“While changes at the hospital- and systems-level may have decreased the proportion of patients without cancer dying in hospital, in-hospital mortality remained substantially higher than that among patients with cancer,” according to the researchers.

The study is limited since it was performed at a single site, and patients’ preferences for acute care utilization and end-of-life care were unknown.