Temporal trends and predictors of inpatient palliative care in metastatic upper urinary tract carcinoma: An observational study.

Overview

abstract

BACKGROUND: Rates and patterns of inpatient palliative care (IPC) use in metastatic upper urinary tract carcinoma (mUTC) are largely unknown. OBJECTIVES: To assess temporal trends and predictors of IPC in patients with mUTC. DESIGN: Relying on the National Inpatient Sample (2008-2019), we identified 3563 mUTC United States inpatients. METHODS: Estimated annual percentage changes (EAPC) analyses as well as logistic regression models addressing IPC use were fitted. Subgroup analyses addressed IPC use according to the number and location of metastatic sites. RESULTS: Of 3563 mUTC inpatients, 540 (15%) received IPC. Overall, the rate of IPC increased from 2 to 22% between 2008 and 2019 (EAPC +10%). In subgroup analyses, the highest increase in IPC use was observed in patients with liver metastases (from 3 to 33%; EAPC + 11%), in patients with bone metastases (from 3 to 29%; EAPC: +10%), and in patients with three or more metastatic sites (from 0.5 to 31%; EAPC: 10%; all p ⩽ 0.003). In multivariable logistic regression models, liver metastases (odds ratio (OR) 1.91, 95% confidence interval (CI) 1.53-2.39), bone metastases (OR 1.83, 95% CI 1.46-2.28), and contemporary year of admission (OR 1.93, 1.57-2.38; all p < 0.001) independently predicted higher IPC rates. Limitations include the retrospective nature of the inpatient database. CONCLUSION: The IPC rate in mUTC was very low (15%). However, this rate increased to approximately 22% in 2019. The highest IPC rates were recorded in contemporary liver (33%), bone (29%), and three or more metastatic sites (31%) United States inpatients. Therefore, clinicians should be sensitized to early IPC use in mUTC patients in general as well as in other metastatic distribution patterns.