Palliative Care Consultations Enhance QOL, Reduce Costs in End-of-Life Esophageal Cancer Care
Palliative care consultations in esophageal cancer improved QOL and reduced financial burden, according to ASCO GI poster findings.
3D rendered medically accurate illustration of esophagus cancer: © Sebastian Kaulitzki - stock.adobe.com
A poster presented at the 2025 ASCO Gastrointestinal Cancer Symposium showed that esophageal cancer patients who had palliative care consultations experienced improved quality of life (QOL) and reduced financial burden due to less intensive interventions during hospitalization at the end of life.
The mean length of hospital stay was 7.5 days (plus or minus 11.3 days) for patients who received palliative care and 8.9 days (plus or minus 14.9) for those who didn’t (P <.001); and total charges were $97,879 (plus or minus $195,868) and $146,128 (plus or minus $321,830), respectively (P <.001). Patients who received palliative care consultation had a Charlson Comorbidity Index of 9.4 (plus or minus 3.3) vs 9.1 (plus or minus 3.5) for patients who did not (P <.001).
Of patients to receive and not to receive a palliative care consultation, 0.9% and 1.6%, respectively, underwent chemotherapy (P <.001); 12.3% and 18.0% underwent blood transfusion (P <.001); and 28.5% and 41.0% underwent mechanical ventilation (P <.001).
“Some patients continue to receive burdensome interventions which significantly deteriorate quality of life,” Suriya Baskar, MD, a second-year resident in the Internal Medicine Department at the Brooklyn Hospital Center, and lead investigator of the study, wrote in the presentation.1 “These findings highlight the importance of early integration of palliative care in [patients with esophageal cancer] with advanced disease.”
In this retrospective study, a total of 17,745 patients were included; 10,370 of whom received palliative care consultation and 7375 of whom did not. Patient data was gathered via a query of the National Inpatient Sample (NIS) to identify all esophageal cancer hospitalizations utilizing the 10th edition of the International Classification of Diseases (ICD-10) codes C15.x between 2016 and 2020.
Per the ICD-10 codes, this includes malignant neoplasms in the: cervical part of the esophagus (C15.0), thoracic part of the esophagus (C15.1), abdominal part of the esophagus (C15.2), the upper third of the esophagus (C15.3), the middle third of the esophagus (C15.4), lower third of the esophagus (C15.5), overlapping lesion of the esophagus (C15.8), and other unspecified parts of the esophagus (C15.9).2
Documented inpatient mortality events that occurred during hospitalizations were stratified based on the reception status of palliative care consultation (ICD-10 code Z51.5)
Of the patients indexed, 20.0% and 19.6% in the palliative consultation and no palliative consultation groups, respectively, were female (P = .56); 13.3% and 71.0%, respectively, were White (P <.001) and 7.8% and 78.4% were black (P <.001). The median age was 67.58 (plus or minus 10.9) in both groups (P = .98).
Chi-squared tests and independent sample t-tests were used to analyze demographic and clinical data for the study.
A non-significant difference was found in the use of vasopressor between those who received a palliative care consultation and those who did not, 8.1% vs 8.0%, respectively (P = .83). There was, however, a significant difference in the rates of do-not-resuscitate orders between patients who did and did not receive palliative care consultations, 78.1% vs 43.2%, respectively (P <.001).
“Esophageal cancer is an aggressive malignancy with a high global prevalence,” Baskar said.1 “Hospitalizations of [patients with esophageal cancer] at [end of life] with palliative care consultations received less aggressive interventions considerably improving QOL while simultaneously reducing financial burden.”
The investigators also highlighted barriers to palliative care consultations, the impact of the timing of palliative care consultations on outcomes, and the number of patients with esophageal cancer that are admitted to hospice at end of life as potential future avenues of research.
Reference
Baskar S. Schoeneich R, Desai C, et al. Impact of inpatient palliative care consultation on end-of-life care among patients with esophageal cancer. J Clin Oncol. 2025;43(4):502. doi:10.1200/JCO.2025.43.4_suppl.502
C15: Malignant neoplasm of oesophagus. Gesund.bund.de. Accessed on January 24, 2025. https://tinyurl.com/ywn4pdms
