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The Role and Timing of Palliative Medicine Consultation for Women With Gynecologic Malignancies: Association With End-of-Life Interventions and Direct Hospital Costs

Nevadunsky, Nicole S.; Gordon, Sharon; Spoozak, Lori; Van Arsdale, Anne; Hou, Yijuan; Klobocista, Merieme; Eti, Serife; Rapkin, Bruce; Goldberg, Gary L.

Obstetrical & Gynecological Survey: July 2014 - Volume 69 - Issue 7 - p 400–402
doi: 10.1097/OGX.0000000000000080
Gynecology: Gynecologic Oncology

ABSTRACT: The aim of this retrospective study was to investigate the association of palliative medicine consultation with inpatient hospital costs and ACE (aggressiveness of care at the end of life) scores in patients with gynecologic malignancies. Data were obtained from inpatient and outpatient medical records of 100 consecutive patients who died of primary gynecologic malignancies at a single institution. Timely consultation for palliative care was defined as exposure to inpatient consultation for 30 days or more before death. Metrics used to tabulate ACE scores included the following: admission to intensive care, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission less than 3 days before death. Hospital accounting records were used to calculate inpatient direct costs for the last 30 days of life. Statistical methods included Fisher exact and Student t testing, Mann-Whitney U testing, and Kaplan-Meier statistics.

Of the total patient sample, 49% (n = 49) had a palliative care consultation, and 18% (n = 18) had timely consultation. The median composite ACE score was significantly lower for patients with timely palliative medicine consultation (≥30 days before death) than for patients with untimely/no consultation: 0 (range, 0–3) versus 2 (range, 0–6), P = 0.025. Median inpatient direct costs were lower for the last 30 days of life among patients with timely consultation than those with untimely consultation: $0 (range, $0–$28,019) versus $7729 ($0–$52,720), P = 0.01.

These data show that timely palliative medicine consultation reduced inpatient direct hospital costs and lowered ACE scores. Prospective studies are needed to validate these findings.

Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women’s Health (N.S.N., S.G., L.S., A.V.A., Y.H., M.K., G.L.G.), and Albert Einstein Cancer Center, Albert Einstein College of Medicine (N.S.N., Y.H., M.K., G.L.G.), Bronx; Department of Palliative Medicine, Beth Israel Medical Center, New York (S.E.); and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx (B.R.), NY

© 2014 by Lippincott Williams & Wilkins.