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Unplanned hospitalizations for metastatic cancers: The changing patterns of inpatient palliative care, discharge to hospice care, and in-hospital mortality in the United States
  1. Jason L. Salemi1,
  2. Charles C. Chima1,
  3. Kiara K. Spooner1 and
  4. Roger J. Zoorob1
  1. 1. Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
  1. Corresponding Author : Jason L. Salemi, PhD, MPH Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA Tel.: +1-713-7984698 E-mail: jason.salemi{at}


Objective To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United States.

Methods We used data from the Nationwide Inpatient Sample to conduct a cross-sectional analysis of unplanned inpatient hospitalizations of patients aged 18 years or older with metastatic cancer from 2002 to 2011. Multivariable logistic regression was used to assess patient-and hospital-level predictors of discharge to hospice care, palliative care, and in-hospital mortality. Temporal trends in outcomes were characterized with use of joinpoint regression.

Results There were an estimated 350,241 unplanned hospitalizations per year of patients with a diagnosis of metastatic cancer. During their inpatient stay, 5.8% of patients received palliative care, and among those discharged alive, 12.2% were referred to hospice care. The rate of inpatient palliative care increased from 2.3% to 13.6%, the rate of discharge to hospice care increased from 4.1% to 15.6%, and the in-hospital mortality rate decreased from more than 14.0% to 9.8%. These patterns were consistent across cancer subtypes, and were most pronounced among patients with extreme risk of mortality.

Conclusion Despite increases in the provision of comfort-oriented care to patients with metastatic cancer, few receive such services. We recommend screening protocols in hospitals to identify patients who are good candidates for palliative care consultation and hospice referral.

  • End-of-life
  • hospice care
  • inpatient mortality
  • metastatic cancer
  • palliative care
  • unplanned hospitalization

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See

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