EoL PC in HNC Patients Is Associated With Lower Hospital Costs, Less Aggressive Care

Background: More aggressive head and neck cancer (HNC) care at the end of life (EoL) is poor quality care. Objective: To understand cost and patient factors in patients with distant HNC metastases between aggressive EoL care and palliative care (PC). Design: Retrospective cohort study. Methods: The National Inpatient Sample database was used to identify patients with distantly metastatic HNC undergoing terminal hospitalization between 2016 and 2020. Aggressive care was defined as ICU level care, chemotherapy, radiotherapy and or surgery at the EoL compared to PC. Results: 43,310 patients were identified, of which 35% met ≥1 of the aggressive interventions and 62% received PC. Among those with aggressive interventions, 77% received ICU care and 19% received surgery. Younger age, lower PC use, larger hospitals, urban teaching hospitals, and high mortality risk were associated with more aggressive care; however, PC was associated with lower hospital costs. Conclusions: PC was associa more...