(0604) Aggressive Inpatient Care at the End of Life for Patients With Head and Neck Cancer

Introduction: Global advancements in cancer treatments have led to more than 50% of patients being treated aggressively during their last month of life. However, aggressive care at the end of life is a marker of poor-quality care and often leads to increased healthcare without necessarily improving survival. We aimed to investigate the use of aggressive care or palliative care (PC) at the end of life (EOL) for patients with head and neck cancer (HNC).

Methods: Patients with HNC with metastatic cancer who died of all-cause mortality during the hospitalization were identified in the National Inpatient Sample database between 2016 and 2020. Univariate analysis was conducted to determine aggressive inpatient care (ICU level of care, chemotherapy, radiotherapy, surgery) at the EOL, and multivariate logistic regression was performed to determine associations with patient and hospital characteristics.

Results: A total of 43,310 deceased patients met the inclusion criteria. Of the patients, 34% received one or more forms of aggressive EOL interventions, and 62% received PC. Among the 12,555 patients, 92% received ICU level of care, 7.6% chemotherapy, 1.1% surgery, and 2.3% radiotherapy treatment. Receipt of PC was significantly associated with fewer aggressive interventions (OR: 0.48; [0.44, 0.53]). Male sex, younger age, bigger hospital size, and urban teaching hospitals were associated with more aggressive interventions. Black race specifically was significantly associated with aggressive EOL care (OR: 1.37; [1.19, 1.57]) and low PC use (OR: 0.77; [0.68, 0.87]) relative to White patients. PC was associated with lower (-$27,089; [ -$35,130, -$19,049]; p < 0.001) and aggressive intervention was associated with higher hospitalization costs ($92,256; [ $86,208, $106,305]; p < 0.001).

Conclusions: Receiving PC at the EOL is associated with less aggressive interventions and costly hospitalization. Efforts to increase PC referral and promote its early uptake can spare patients, particularly Black patients, from futile treatment, poor EOL quality, and costly hospitalizations.