Trends in Palliative Care Utilization in Patients with Bone Metastases.
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2025-10
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Abstract
Background: Bone metastases cause significant symptom burden, yet patterns of palliative care (PC) utilization in this population remain poorly characterized. Objectives: To evaluate trends in PC use, compare inpatient palliative care (IPPC) and outpatient palliative care (OPPC) utilization, identify predictors of PC engagement, and assess the impact on readmissions. Methods: Using the PearlDiver database (2011-2021), patients with bone metastases were identified. PC encounters were classified as IPPC or OPPC. Trends were assessed with linear regression; predictors and outcomes were evaluated using multivariate logistic regression. Results: Of 471,713 patients, 17.2% received PC. Overall PC use did not increase significantly from 2011 to 2021 (p = 0.14), though OPPC rose from 0.7% to 2.6% (R2 = 0.87). Predictors of PC use included younger age (mean age 64 vs. 66 years, p < 0.001), female gender, higher comorbidity burden, Medicaid insurance, and region (p < 0.01 for all). Receipt of OPPC within six months of hospice was associated with 77% lower odds of readmission (Odds Ratio (OR): 0.23, 95% Confidence Interval (CI): 0.17-0.30, p < 0.001). Conclusion: PC utilization remains low in this population. OPPC use has modestly increased and is associated with reduced readmissions prior to hospice referral. Expanding OPPC may reduce hospitalizations and improve care quality.
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Rowe, Dana G, Joshua Woo, Seeley Yoo, Ellen O'Callaghan, Nicole Rivera, Kerri-Anne Crowell, Tara Dalton, Elizabeth Fricklas, et al. (2025). Trends in Palliative Care Utilization in Patients with Bone Metastases. Journal of palliative medicine. 10.1177/10966218251388233 Retrieved from https://hdl.handle.net/10161/34358.
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Scholars@Duke
Christopher Jones
Julia Dawn Visgauss
I specialize in pelvic resection and reconstructive surgery. I have a special interest in researching and understanding how people’s gait is affected by pelvic surgery, and how we can improve reconstructive techniques in order to optimally balance restoration of anatomy and function.
My translational research is focused on understanding what drives disease progression and treatment resistance in sarcoma. Currently my focus is in chondrosarcoma, a subtype of bone sarcoma that produces cartilage, and has extremely limited treatment options beyond surgery. My lab is working to uncover the cellular derangements and immune interactions that allow these cells to metastasize, and develop targeted systemic therapies to improve patient outcomes.
Trey Carlton Mullikin
Margaret Johnson
I am a neuro-oncologist, neurologist, and palliative care physician at the Preston Robert Tisch Brain Tumor Center. I also provide neuro-oncology expertise for the National Tele-Oncology Program and National Precision Oncology Program at the Veteran's Health Administration. My clinical and research interests encompass supportive care and palliative care with a special interest in older adults with brain tumors. The incidence of malignant brain tumors like glioblastoma and non-malignant tumors like meningioma affect aging populations and it is crucial to be able to provide better care for these patients.
Melissa Maria Erickson
I am a spine surgeon who provides surgical management of cervical, thoracic and lumbar spine conditions, including cervical myelopathy, herniated discs, deformity, stenosis, tumor and trauma. I provide both minimally invasive procedures as well as traditional surgical techniques.
Courtney Rory Goodwin
Associate Professor of Neurosurgery, Radiation Oncology, Orthopedic Surgery.
Director of Spine Oncology,
Associate Residency Program Director
Third Year Study Program Director Neurosciences, Duke University School of Medicine
Director of Spine Metastasis, Duke Center for Brain and Spine Metastasis, Department of Neurosurgery
Duke Cancer Institute, Duke University Medical Center
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