Palliative Care Utilization in Mesothelioma: Insights from the National Inpatient Sample (2016-2020)

Objectives Mesothelioma is a rare and fatal cancer with a median survival of about 1 year after diagnosis. Palliative care (PC) becomes important in improving symptom control and quality of life in cancer patients. However, there is no literature regarding specific determinants of PC utilization in hospitalized mesothelioma patients. We studied the trends and determinants in utilization of PC, and its impact on hospital costs using the National Inpatient Sample. Methods A retrospective cross-sectional study was conducted based on data from 2016 to 2020. Adults above 18 years of age hospitalized for mesothelioma (ICD-10-CM C45) were identified. In this set of patients, PC encounters were identified using ICD-10-CM Z51.5. Main outcomes measured were predictors of inpatient PC, hospitalization charges, and clinical outcomes. Results Of 13 745 mesothelioma hospitalizations between 2016 and 2020, 14.2% had an encounter with PC. Utilization was higher among Medicaid-insured patients (7.4% vs 4.0%, P = .005), those with heart failure (17.2% vs 10.4%, P < .001), and acute kidney injury (24.4% vs 12.7%, P < .001). PC was less frequent in large hospitals and obese patients. After adjusting for confounders in the multivariate regression analysis, PC was associated with a $29 259 reduction in hospitalization charges ( P < .001). Conclusions Inpatient PC use in mesothelioma remains low but is associated with lower hospitalization costs. These findings support the need for systematic early PC integration in Mesothelioma management in a hospital setting.