Association Between Timing of Specialist Palliative Care and End-Of-Life Healthcare Utilization in Patients With Colorectal Cancer and Related Intestinal Cancers: A Nationwide Register-Based Study.

Abstract

IntroductionPatients with colorectal cancer and other intestinal cancers often experience a high symptom burden and frequently require healthcare services near the end of life (EOL). Early involvement of specialist palliative care (SPC) has been shown to improve quality of life and reduce aggressive EOL care, but data on its timing in this population is limited. This study examined the association between timing of SPC contact and healthcare utilization at the EOL.Patients and MethodsThis nationwide retrospective cohort study included all patients who died from colorectal cancer and other intestinal cancers in Finland in 2019. Data on healthcare use were obtained from national registers. Patients were categorized based on the timing of their first SPC contact into early (>30 days before death) and late or no SPC contact (≤30 days or none). Healthcare utilization in the last month of life was compared between groups, and multivariable logistic regression was used to identify factors associated with acute care.ResultsA total of 1445 patients were included, of whom 339 (23%) received early SPC contact, with a median of 142 days before death. Early SPC contact was associated with fewer emergency department (ED) contacts (43% vs. 54%, p<0.001) and secondary care hospitalizations (21% vs. 49%, p<0.001) and with a lower likelihood of death in hospital (59% vs. 80%, p<0.001). In multivariable analyses, late or no SPC contact was associated with higher odds of ED contacts (odds ratio (OR) 1.613, 95% confidence interval (CI) 1.255-2.074) and hospitalizations (OR 4.029, 95% CI 2.998-5.415).ConclusionsSPC contact occurring more than 30 days before death was associated with lower acute care use and fewer hospital deaths among patients with colorectal cancer and other intestinal cancer. These findings support consideration of earlier integration of SPC in the disease trajectory and warrant further prospective studies evaluating its impact on EOL care and healthcare utilization.