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UPJ INSIGHT Palliative Care, Hospice, and End-of-Life Health Care in Patients With Malignant Ureteral Obstruction

By: Michael D. Felice, MD, Loyola University Medical Center, Maywood, Illinois; Elizabeth L. Koehne, MD, Loyola University Medical Center, Maywood, Illinois, University of Washington, Seattle; Hiten D. Patel, MD, MPH, Loyola University Medical Center, Maywood, Illinois, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Nicholas Elliott, MD, Loyola University Medical Center, Maywood, Illinois; Lauren Hekman, BA, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois; Owen Lewer, BS, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois; Farah Rahman, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois; Sofia Petix, Hope College, Holland, Michigan; Jeffrey Ellis, MD, Loyola University Medical Center, Maywood, Illinois; Grace Delos Santos, MD, Loyola University Medical Center, Maywood, Illinois | Posted on: 19 Jan 2024

Felice MD, Koehne EL, Patel HD, et al. The current status of palliative care, hospice, and end-of-life health care utilization in patients with malignant ureteral obstruction. Urol Pract. 2024;11(1):187-196.

Study Need and Importance

Malignant ureteral obstruction (MUO) is associated with a poor prognosis. Most patients with MUO would benefit from concurrent dedicated palliative care services based on American Society of Clinical Oncology guidelines. Currently, palliative care and hospice utilization in patients with MUO is unknown.

What We Found

Most patients with MUO did not receive dedicated palliative care services, and roughly half of the cohort utilized hospice. Time spent on both palliative care and hospice was short. Neither palliative care nor hospice utilization was associated with decreased overall survival (Figure). Forty-three percent of patients with MUO had high end-of-life health care utilization. Notably, hospice drastically reduced end-of-life health care utilization.

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Figure. Kaplan-Meier overall survival curves, stratified by palliative care utilization. Of the patients 39.1% (45/115) utilized palliative care. Palliative care utilization was not associated with worse overall survival (HR 1.249, 95% CI 0.841-1.885, P = .262).

Limitations

This was a single-institution retrospective study which limited assessment of patient-reported outcomes. The study institution was a tertiary care center which may limit generalizability of the study. Lastly, the cohort size was small which likely limited the ability to accurately identify factors associated with palliative care, hospice, and end-of-life health care utilization.

Interpretation for Patient Care

Concurrent palliative care is known to improve quality of life and decrease end-of-life health care utilization, without negatively impacting survival in patients with advanced cancer. Despite high-quality evidence, concurrent palliative care services are underutilized in patients with MUO. Future prospective, multi-institutional research is needed to elucidate the impact of concurrent palliative care in patients with MUO. Furthermore, the creation of urology-specific palliative care guidelines, with consideration of MUO, may be beneficial.

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