title: Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer.
abstract: BACKGROUND
  Substantial health care resources are used on aggressive end-of-life care, despite an increasing recognition that palliative care improves quality of life and reduces health care costs. We examined the incidence of palliative care encounters in in-patients with incurable head and neck cancer and associations with in-hospital mortality, length of hospitalization, and costs.
  
  
  METHODS
  Data from the Nationwide Inpatient Sample (NIS) for 80,514 head and neck cancer patients with distant metastatic disease in 2001 to 2010 was analyzed using cross-tabulations and multivariate regressions.
  
  
  RESULTS
  Palliative care encounters occurred in 4029 cases (5%) and were significantly associated with age ≥80 years, female sex, self-pay payor status, and prior radiation. Palliative care was significantly associated with increased in-hospital mortality and reduced hospital-related costs.
  
  
  CONCLUSIONS
  Inpatient palliative care consultation in terminal head and neck cancer is associated with reduced hospital-related costs, but appears to be underutilized and restricted to the elderly, uninsured, and patients with an increased risk of mortality.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Mulvey
authors.affiliation: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000628:therapy*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Nationwide Inpatient Sample; complications; costs; head and neck neoplasms; palliative care