Timing of palliative care integration and acute care utilization in metastatic prostate cancer: A quality improvement analysis.

Abstract

309 Background: Patients with metastatic prostate cancer experience high symptom burden and frequent acute care utilization. Although early integration of palliative care (PC) is recommended, its implementation remains inconsistent, particularly in safety-net settings. We evaluated patterns and timing of PC utilization and their association with acute care outcomes to identify targets for quality improvement. Methods: We conducted a retrospective cohort study of patients with metastatic prostate cancer treated at a safety-net academic center from 2016–2025. Patients were categorized by PC utilization (PC vs no PC) and timing of referral (early ≤60 days vs late >60 days from metastatic diagnosis). Timing of PC relative to first hospitalization and patterns of analgesic use were evaluated. Supportive services were defined as utilization of nutrition, social work, rehabilitation/physical therapy, dental care, or hospice services. Multivariable regression models assessed associations with acute care outcomes. Results: Among 184 patients, 40.2% received PC; only 28.4% had early referral (≤60 days). Most PC consults occurred after the first hospitalization (73%), with fewer during (21%) and prior to admission (6%). Patients receiving PC had higher baseline functional impairment (ECOG 0.9 vs 0.6, p=0.023) and greater utilization of supportive services (94.6% vs 72.7%, p<0.001). PC patients demonstrated higher acute care utilization, including mean ED visits (1.70 vs 0.92), hospitalizations (1.91 vs 1.14), and ICU admissions (23.0% vs 10.0%). After adjustment, PC was associated with increased ED visit counts (IRR 1.57, 95% CI 1.01–2.47, p=0.050), but not hospitalization counts (IRR 1.04, p=0.817). A non-significant trend toward increased ICU utilization was observed (IRR 2.00, p=0.078). In binary models, PC was not associated with frequent ED visits (≥2) or hospitalization, with a trend toward increased ICU admission (OR 2.24, p=0.086). Opioid use was common prior to referral, with most patients receiving short-acting opioids (92%) and long-acting opioids (67%). Conclusions: Patients with metastatic prostate cancer who receive palliative care represent a higher-acuity population with increased symptom burden and acute care utilization. Our findings identify a subgroup of patients who may benefit from earlier integration of palliative care. These results support the development of targeted strategies to improve timely access to outpatient palliative care, with the goal of optimizing symptom management and reducing high-intensity care. Proactive integration of palliative care may improve care delivery and patient outcomes. Outcome No PC PC Adjusted Effect p-value ED visits (mean) 0.92 1.70 IRR 1.57 (1.01–2.47) 0.050 Hospitalizations (mean) 1.14 1.91 IRR 1.04 (0.72–1.51) 0.817 ICU admission ≥1 (%) 10.0% 23.0% OR 2.24 (0.91–5.84) 0.086