Trends in Palliative Care Utilization in Patients with Bone Metastases.

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.