Objective This observational study explores the association between palliative care (PC) involvement and high-cost imaging utilisation for patients with cancer patients during the last 3 months of life.
Methods Adult patients with cancer who died between 1 January 2012 and 31 May 2015 were identified. Referral to PC, intensity of PC service use, and non-emergent oncological imaging utilisation were determined. Associations between PC utilisation and proportion of patients imaged and mean number of studies per patient (mean imaging intensity (MII)) were assessed for the last 3 months and the last month of life. Similar analyses were performed for randomly matched case-control pairs (n = 197). Finally, the association between intensity of PC involvement and imaging utilisation was assessed.
Results 3784 patients were included, with 3523 (93%) never referred to PC and 261 (7%) seen by PC, largely before the last month of life (61%). Similar proportions of patients with and without PC referral were imaged during the last 3 months, while a greater proportion of patients with PC referral were imaged in the last month of life. PC involvement was not associated with significantly different MII during either time frame. In the matched-pairs analysis, a greater proportion of patients previously referred to PC received imaging in the period between the first PC encounter and death, and in the last month of life. MII remained similar between PC and non-PC groups. Finally, intensity of PC services was similar for imaged and non-imaged patients in the final 3 months and 1 month of life. During these time periods, increased PC intensity was not associated with decreased MII.
Conclusions PC involvement in end-of-life oncological care was not associated with decreased use of non-emergent, high-cost imaging. The role of advanced imaging in the PC setting requires further investigation.
- palliative care
- end of life care
- resource utilization
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Contributors KR, TC, MR, SP and BF contributed to study design, data acquisition, analysis and interpretation. ML and AM were integral for data acquisition and contributed to data interpretation. DO and DS contributed to data analysis and interpretation. KR, TC and BF drafted the manuscript. All authors assisted with critical review and revision of the manuscript. The final submission has been approved by all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SZP reports grants from the Alafi Family Foundation, Stupski Foundation, and Hellman Family Foundation during the conduct of the study. DS reports financial reimbursements from the American College of Radiology, American Society of Neuroradiology, National Quality Forum, Centers for Medicare and Medicaid Services, Health Services Advisory Group, Sutter Medical Group, and Radiological Associates Medical Group outside the submitted work; and DS receives financial reimbursement for serving as an expert witness and a medical consultant for several legal cases.
Provenance and peer review Not commissioned; externally peer reviewed.