Jun 29, 2015
Numerous studies have shown that patients who receive early palliative experience greater physical health and quality of life—and that these benefits extend to patients’ families as well. Studies have also shown that palliative care, which includes the management of symptoms such as pain, nausea, and anxiety; psychosocial counseling; and discussion about treatment goals and expectations, is associated with lower costs of care, compared with routine, standard treatment. Few studies, however, have assessed how the timing of palliative care affects cost. A new Journal of Clinical Oncology (JCO) study, “Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients with Advanced Cancer: Earlier Consultation is Associated with Larger Cost-Saving Effect,” set out to address this gap in the research.
The study, published online, ahead of print, June 8, looked at 969 patients with advanced cancer who were admitted for hospitalization at five, large U.S. hospitals. Data analysis showed that having an earlier palliative care consultation was associated with lower costs. Specifically, the study found that a palliative care intervention within six days of admission was estimated to reduce costs by $1312 compared with standard treatment, and that an intervention within two days of admission was estimated to reduce costs even further, by $2280. These cost-reductions are equivalent to 14% and 24% reductions in cost of hospital stay, respectively.
Commenting on these findings, the study’s first author, Peter May, MS, of the Centre for Health Policy and Management at Trinity College in Dublin, Ireland, said:
“By incorporating time into our analysis, we were able to show not only that consultation teams reduce cost of hospital care but that the cost reduction is greatest when the consult is given promptly following hospitalization. The cost impact of palliative care early in the hospitalization is shown to be larger than understood from previous studies.”
Lower cost attributed to shorter length of stays and less intense treatments
Mr. May attributed the study’s findings to the fact that patients who receive palliative care, compared with patients who receive standard care, are more likely to receive less intense treatments while in the hospital and to have shorter length of stays—two factors that reduce overall costs of care.
“Palliative care includes expert pain and symptom management, discussions about goals of care, and transition management,” said Mr. May. “In terms of less intense treatments, patients who are candidates for palliative care are seriously ill and sometimes have diminished life expectancy. For these patients, goals of care discussions that consider both the burdens and benefits of high intensity treatments are critical for ensuring patient-centered care. For many patients, enhanced quality of life and the opportunity to be at home with their loved ones is of higher priority than being in the hospital receiving burdensome interventions with a low likelihood of success. These conversations lead to more informed patients, less intense burdensome treatments, better quality of life, and lower cost of care.”
In explaining why patients treated with palliative care also have shorter hospital stays, Mr. May cited the transition management piece of palliative care. “In transition management, the palliative care team ensures that complex, seriously ill patients have a plan in place to ensure their needs are met when leaving the hospital. Having a safe homecare plan is a factor in patients leaving the hospital early, thus reducing cost.”
Peter May is HRB Economics of Cancer Fellow at the Centre for Health Policy and Management in Trinity College Dublin and a Visiting Researcher with the Icahn School of Medicine at Mount Sinai in New York.
Abstract of the original JCO article.
PDF of the original JCO article.
May P, Garrido MM, Cassel JB, et al. Prospective cohort study of hospital palliative care teams for inpatients with advanced cancer: earlier consultation is associated with larger cost-saving effect. J Clin Oncol. Epub 2015 June 8.
The Exclusive Coverage series on ASCO.org highlights selected research from JCO and JOP with additional perspective provided by the lead or corresponding author.
@ 2014 American Society of Clinical Oncology