Effect of Specialist Palliative Care on Acute Healthcare in Stage IV Cancer: Prior Event Rate Ratio

Abstract

Context: The evidence for effect of specialist palliative care (SPC) on acute healthcare utilization is limited and inconclusive. Furthermore, randomized controlled trials may not reflect real-world clinical settings. Objectives: Effect of SPC on subsequent emergency department (ED) visits and inpatient hospitalizations among patients with stage IV cancer using real-world data and a novel prior event rate ratio (PERR) approach with bias-correction. Methods: Retrospective observational cohort study using the PERR method to compare ED visits and inpatient hospitalizations among patients with stage IV cancer who did vs did not receive SPC. We included patients diagnosed with stage IV cancer at National Cancer Centre Singapore between January 2019 and December 2022 and followed them up to July 2023. Each patient who received SPC was then matched with replacement to up to three patients who did not receive SPC during the study duration. Results: Among 7144 patients with stage IV cancer, 1499 (21.0%) received SPC by July 2023. After 1:3 matching with replacement, there were 5948 patients in the matched cohort. Compared to those who never received SPC, those who received SPC had a PERR hazard ratio estimate of 0.644 (95% confidence interval 0.524–0.792; P < 0.001) for ED visits and 0.633 (95% confidence interval 0.539–0.743; P < 0.001) for hospitalizations. Although reduction was greater with earlier initiation of SPC (test of interaction, P < 0.001), the reduction remained significant even if SPC was initiated about one year after stage IV cancer diagnosis. Conclusion: SPC was associated with lower rates of ED visits and hospitalizations.