RPD110 - Utilization of Palliative Care in Metastatic Pancreatic Cancer: Insights From The National Inpatient Sample

Key Message : Palliative care in metastatic pancreatic cancer was associated with lower hospital charges and reduced likelihood of certain invasive interventions, including CVC placement, TPN initiation, pancreatic resection, and ERCP, without significant differences in others. These findings reflect the need for further research to understand the mechanisms driving these differences.

Abstract: Background
Pancreatic cancer accounts for only 3% of cancers in the United States yet is the third leading cause of cancer-related mortality [1,2]. Most patients present with advanced disease. Evaluating the impact of palliative care (PC) on patient outcomes is essential to identifying opportunities to enhance the quality and efficiency of care in this population.

Methods
We conducted a retrospective cohort study using the National Inpatient Sample (2016–2021). Adult patients hospitalized with metastatic pancreatic cancer (mPC) were identified using ICD-10 codes and stratified by receipt of PC during hospitalization. The primary outcome was resource utilization, measured by length of stay (LOS) and total hospital charges (THC). Secondary outcomes included utilization of mechanical ventilation, vasopressor use, central venous catheter [CVC] placement, tracheostomy, percutaneous endoscopic gastrostomy (PEG) placement, total parenteral nutrition (TPN), pancreatic resection, and endoscopic retrograde cholangiopancreatography (ERCP). Multivariate regression models were used for analysis.

Results
A total of 21,547 weighted hospitalizations were included, of which 5,294 (24.57%) received PC. Multivariate analysis showed that PC was associated with a slight increase in LOS by 0.33 days (95% confidence interval [CI], 0.08–0.58; p=0.01) but with lower THC by $11,458 (95% CI, –14,581 to –8,335; p< 0.01). PC was also associated with lower odds of CVC placement (adjusted odds ratio [aOR] 0.73, 95% CI 0.55–0.96; p< 0.03), TPN initiation (aOR 0.77, 95% CI 0.61–0.97; p< 0.03), pancreatic resection (aOR 0.34, 95% CI 0.15–0.79; p=0.01), and ERCP (aOR 0.72, 95% CI 0.64–0.81; p< 0.01). No significant differences were observed for mechanical ventilation, vasopressor use, tracheostomy, or PEG placement.

Conclusion
Among hospitalized patients with metastatic pancreatic cancer, inpatient palliative care was associated with lower THC and reduced likelihood of certain invasive procedures, despite a small increase in LOS. These findings reflect the need for further research to understand the mechanisms driving these differences.

References: 1. American Cancer Society. (2025, September). Facts About Pancreatic Cancer. Cancer. https://www.cancer.org/cancer/types/pancreatic-cancer/about/key-statistics.html.

2. National Cancer Institute. (2025, September). Cancer Stat Facts: Pancreatic Cancer. U.S. Department of Health and Human Services National Institutes of Health. https://seer.cancer.gov/statfacts/html/pancreas.html.