title: The Costs of Waiting: Implications of the Timing of Palliative Care Consultation among a Cohort of Decedents at a Comprehensive Cancer Center.
abstract: BACKGROUND
  Palliative care is recommended along with oncologic care for patients with advanced cancer. However, there are limited data about how the timing of palliative care affects quality and costs.
  
  
  OBJECTIVE
  Comparison of health care utilization and care quality for patients with cancer who died having received early versus late palliative care.
  
  
  METHODS
  Analysis of cancer registry, administrative, and billing databases.
  
  
  METHODS
  Patients with cancer who died having received specialty palliative care consultation.
  
  
  METHODS
  Comparing early (more than 90 days prior to death) versus late (less than 90 days prior to death) palliative care, outcome measures included rates of health care utilization and health care costs.
  
  
  RESULTS
  Among 922 decedents, 297 (32.2%) had palliative care referrals, with 93 (10.1%) receiving early referrals and 204 (22.1%) late referrals. Compared to patients receiving late palliative care, early palliative care patients had lower rates of inpatient (33% versus 66%, p < 0.01), ICU (5% versus 20%, p < 0.01), and ED utilization (34% versus 54%, p = 0.04) in the last month of life. Direct costs of inpatient care in the last 6 months of life for patients with early palliative care were lower compared to late palliative care ($19,067 versus $25,754, p < 0.01), while direct outpatient costs were similar ($13,040 versus $11,549, p = 0.85). Early palliative care was predominantly delivered in the outpatient setting (84%) while late palliative care was mostly delivered in the hospital (82%).
  
  
  CONCLUSIONS
  Early palliative care is associated with less intensive medical care, improved quality outcomes, and cost savings at the end of life for patients with cancer. Despite recommendations that early palliative care be offered to all patients with metastatic cancer, palliative care services remain underutilized.
authors.affiliation: 1 Department of Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Colin
authors.initials: C
authors.lastname: Scibetta
authors.affiliation: 2 Kerr Healthcare Analytics , Mill Valley, California.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kerr
authors.affiliation: 3 UCSF Cancer Registry, University of California , San Francisco, San Francisco, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mcguire
authors.affiliation: 1 Department of Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D010166:Palliative Care / Q000191:economics* / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States; D055815:Young Adult