First Unscheduled Hospitalization in Pancreatic Cancer: A Point for Palliative Care Integration.

Context

Pancreatic cancer is characterized by high symptom burden, rapid deterioration, and poor survival. Despite this complexity, specialist palliative care (SPC) is often integrated late or not at all. The first unscheduled hospitalization may represent a point for SPC assessment.

Objectives

To characterize frequency, clinical features, and outcomes of the first unscheduled hospitalization in pancreatic adenocarcinoma, explore factors associated with subsequent survival, and describe the timing of SPC assessment.

Methods

We conducted a retrospective cohort study of consecutive adults with pancreatic adenocarcinoma managed by medical oncology at three tertiary hospitals during 2022-2023, with follow-up through 2025. Overall survival (OS) from hospitalization was estimated with Kaplan-Meier methods; univariable Cox regression assessed associations with survival.

Results

Among 125 patients, 105 (84%) experienced a first unscheduled hospitalization at a median of 4.1 months after diagnosis (IQR, 1.9-8.0). Median OS was 3.8 months (95% CI, 2.1-7.1); 21/104 (20%) died in hospital, and 62/80 (78%) were readmitted after discharge. ECOG performance status 2-4 (HR, 3.30), metastatic disease (HR, 3.05), liver metastases (HR, 2.58), and strong opioid use (HR, 2.10) were associated with shorter survival. Only 11 (10%) underwent SPC assessment before hospitalization; 31 (30%) were first assessed during hospitalization, 40 (38%) afterward, and 23 (22%) remained unassessed.

Conclusion

A first unscheduled hospitalization occurred in most patients, marking limited survival, high in-hospital mortality, and frequent readmission. Most lacked prior SPC assessment. This event may serve as a pragmatic safety net for palliative care integration, complementing earlier needs- and prognosis-based referral strategies.