title: How different is the care of terminal pancreatic cancer patients in inpatient palliative care units and acute hospital wards? A nationwide population-based study.
abstract: BACKGROUND
  Inpatient palliative care is important for patients with terminal pancreatic cancer. However, the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer have not been explored in a population-based study.
  
  
  METHODS
  This population-based nationwide study was conducted using data from the Taiwan National Health Insurance database to analyze the differences between inpatient palliative care and acute hospital care for inpatients with pancreatic cancer. We identified 854 patients with terminal pancreatic cancer, who had received in-hospital end-of-life care between January 2003 and December 2006. These patients were then sub-divided and matched 1:1 (using propensity score matching) according to whether they received inpatient palliative care (n = 276) or acute hospital care (n = 276). These groups were subsequently compared to evaluate any differences in the use of aggressive procedures, prescribed medications, and medical costs.
  
  
  RESULTS
  Inpatient palliative care was typically provided by family physicians (39%) and oncologists (25%), while acute hospital care was typically provided by oncologists (29%) and gastroenterologists (24%). The inpatient palliative care group used natural opium alkaloids significantly more frequently than the acute hospital care group (84.4% vs. 56.5%, respectively; P < 0.001). The inpatient palliative care group also had shorter hospital stays (10.6 ± 11.1 days vs. 20.6 ± 16.3 days, respectively; P < 0.001), fewer aggressive procedures, and lower medical costs (both, P < 0.005).
  
  
  CONCLUSIONS
  Compared to patients in acute hospital wards, patients with pancreatic cancer in inpatient palliative care units received more frequent pain control treatments, underwent fewer aggressive procedures, and incurred lower medical costs. Therefore, inpatient palliative care should be considered a viable option for patients with terminal pancreatic cancer.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.|National Yang-Ming University School of Medicine, Taipei, Taiwan.|Department of Internal Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
authors.forename: Jack P
authors.initials: JP
authors.lastname: Wang
authors.affiliation: Department of Dermatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan. chenyiok@gmail.com.|Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan. chenyiok@gmail.com.
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: College of Healthcare Administration and Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
authors.forename: I-Hsuan
authors.initials: IH
authors.lastname: Hwang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.|National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Kao
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.|National Yang-Ming University School of Medicine, Taipei, Taiwan.|Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Hung
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan.|Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan. cpli@vghtpe.gov.tw.|National Yang-Ming University School of Medicine, Taipei, Taiwan. cpli@vghtpe.gov.tw.
authors.forename: Chung-Pin
authors.initials: CP
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003365:Costs and Cost Analysis / Q000592:standards; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000191:economics*; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000628:therapy*; D013624:Taiwan
chemical_list: D000701:Analgesics, Opioid