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

OBJECTIVE: Aggressive care at the end of life (EoL) is a marker of poor-quality care for patients with advanced head and neck cancer (HNC). We aimed to investigate aggressive inpatient care and palliative care (PC) at the EoL for hospitalized patients with distant metastases. STUDY DESIGN: Retrospective cohort study. SETTING: Patients with metastatic head and neck cancer and terminal hospitalization were identified in the National Inpatient Sample database between 2016 and 2020. METHODS: We examined the level of aggressive inpatient care (intensive care unit (ICU) level of care, chemotherapy, radiotherapy, and surgery) and PC at the EOL. Multivariate logistic regression was performed to determine their associations with selected patient and hospital characteristics. RESULTS: A total of 43 310 patients met the inclusion criteria. Thirty-five percent of patients received one or more forms of aggressive EOL interventions, and 61.76% received PC. Among the 15 095 receiving aggressive intervention, 76.9% received ICU level of care, 12.18% received chemotherapy, 19.2% surgery, and 8.04% radiotherapy during their terminal hospitalization. In multivariable analyses, younger age, lower PC use, larger hospitals, urban teaching hospitals, and higher risk of mortality were associated with a greater likelihood of aggressive care. PC was associated with lower hospital costs (-$20,115; [-$28,284, -$11,946]) and aggressive care was associated with higher terminal hospitalization costs ($100,309; [$91,373, $109,245]). CONCLUSION: Receiving PC at the EoL was associated with less aggressive interventions and costly hospitalization. Further research should examine these associations using prospective designs and evaluate whether increased PC referral and early uptake might help diminish poor quality of care and costly hospitalizations.