Palliative care offers greater cost savings for cancer patients with multiple chronic conditions

January 05, 2016

Patients with incurable cancer and numerous other serious health conditions who consulted with a palliative care team within two days of hospitalization had significant savings in hospital costs, according to a new study led by researchers at the Icahn School of Medicine at Mount Sinai. Published today in the January issue of the journal Health Affairs, the study also determined that the higher number of serious coexisting conditions patients had, the greater reduction in direct hospital costs.

While previous studies have shown the link between palliative care and lower costs, this is the first study to examine whether the effect of palliative care consultation varies by the number of co-existing chronic conditions. Researchers compared a treatment group of advanced cancer patients with numerous serious health conditions (also known as comorbidities) from six hospitals who were seen by a palliative care team with a separate group who received usual care. Findings indicated that patients from the treatment group on average had a 22 percent reduction in costs compared to the group that did not receive palliative consultation. Data showed that patients with the highest number of comorbidities had up to a 32 percent reduction in costs. The study's findings suggest that early palliative consultations with the sickest patients may decrease unwanted aggressive end-of-life care, as well as shorten length of stays in hospital.

Palliative care is a team-based specialty (incorporating medicine, nursing, social work and chaplaincy) focused on improving quality of life for people with serious illnesses by adding a layer of support for patients, their families, and health care providers. It is provided in conjunction with all other appropriate medical treatments, including curative and life-prolonging therapies. Programs using palliative care consultation teams have rapidly expanded in recent years. Today, over 90 percent of medium-size to large U.S. hospitals now have palliative care teams.

"We already know that coordinated, patient-centered palliative care improves care quality, enhances survival, and reduces costs for persons with cancer," said R. Sean Morrison, MD, Director of the National Palliative Care Research Center and Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and lead author of the study. "Our latest research now shows the strong association between cost and the number of co-occurring conditions. Among patients with advanced cancer and other serious illnesses, aggressive treatments are often inconsistent with patients' wishes and are associated with worse quality of life compared to other treatments. It is imperative that policymakers act to expand access to palliative care."

Patients with multimorbidities account for a high proportion of U.S. health care spending. They also comprise two-thirds of Medicare beneficiaries and account for almost half of the program's total spending. According to the Centers for Medicare and Medicaid Services (CMS), over the next decade, annual Medicare expenditures will increase by 98 percent and total annual national health spending will grow by 76 percent, reaching $5.4 trillion. Increasing access to palliative care during hospitalization for patients with advanced cancer and multiple chronic conditions could both improve care and help curb the growth of health care spending.

"The fact that we found greater cost savings for cancer patients with more comorbidities than for those with fewer comorbidities raises the question of whether similar results would be observed in patients with other serious illnesses and multimorbidity," said Professor Peter May of Trinity College Dublin and a former visiting research fellow in the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and co-author of the study. "Future research is also needed to determine when in the course of illness palliative care is most cost-effective."
-end-
The study was supported by the National Cancer Institute (NCI) and the National Institute of Nursing Research. Additional collaborators include researchers from Johns Hopkins University, Trinity College Dublin, Virginia Commonwealth University and James J. Peters VA Medical Center.

About the Mount Sinai Health System

The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services--from community-based facilities to tertiary and quaternary care.

The System includes approximately 6,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is ranked as one of the nation's top 10 hospitals in Geriatrics, Cardiology/Heart Surgery, and Gastroenterology, and is in the top 25 in five other specialties in the 2015-2016 "Best Hospitals" issue of U.S. News & World Report. Mount Sinai's Kravis Children's Hospital also is ranked in seven out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology, while Mount Sinai Beth Israel is ranked regionally.

For more information, visit http://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

The Mount Sinai Hospital / Mount Sinai School of Medicine

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.