End-of-Life Care Among Patients With Neuroendocrine Tumors: Underutilization of Palliative Care and Racial Disparities.

Abstract

Background: Neuroendocrine tumors (NETs) are a diverse group of malignancies with increasing incidence. Early diagnosis is challenging-most patients present with advanced disease, which is associated with a heavy symptom burden. The role of palliative care in the management of NETs is critical but inadequately explored. We sought to investigate the utilization of palliative care and examine racial disparities in end-of-life (EoL) care among patients with NETs.

Methods: We analyzed National Inpatient Sample (NIS) data from 2016 to 2020, including hospitalizations involving patients with NETs who experienced inpatient mortality. Palliative care consultation rates, do-not-resuscitate (DNR) status, and aggressive treatment interventions were assessed. Comparative analysis between White and Black patients was conducted using logistic regression to determine associations with palliative care consultation and EoL care.

Results: Among 7,215 patients with NETs, 60.7% received palliative care consultation at EoL. Palliative care consultation was more frequent in males and patients aged 50-75 years. It was associated with a higher likelihood of DNR code status (OR, 5.2; 95% CI, 4.7-5.8) and a reduced incidence of aggressive treatments such as mechanical ventilation (OR, 0.47; 95% CI, 0.43-0.52) and vasopressor administration (OR, 0.70; 95% CI, 0.60-0.82). Black patients were less likely to receive palliative care consultation (adjusted OR, 0.70; 95% CI, 0.62-0.80) and to have DNR code status (adjusted OR, 0.81; 95% CI, 0.71-0.92), and were more likely to undergo aggressive interventions such as mechanical ventilation at EoL (adjusted OR, 1.54; 95% CI, 1.35-1.76).

Conclusions: Our study shows that approximately 40% of hospitalized patients with NETs do not receive palliative care consultation at EoL, and that significant racial disparities exist. These findings underscore the need for enhanced integration of palliative care and targeted interventions to address racial disparities in EoL care among patients with NETs.