Specialist palliative care is associated with reduced healthcare utilization in patients with advanced esophageal and gastric cancer: a nationwide register-based study

Abstract Background and purpose Esophageal and gastric cancer patients, with poor prognoses and complex symptom burdens, require comprehensive end-of-life care. This study evaluated the impact of specialist palliative care (SPC) on end-of-life healthcare utilization. Material and methods We retrospectively analyzed nationwide healthcare utilization data for all adults who died of esophageal or gastric cancer in Finland in 2019, using National Health and Social Care Registers. Patients were compared based on timing of first SPC contact: early (>30 days before death) or no/late (≤30 days). Results The cohort included 732 patients (median age 72 years), with 233 (32%) having SPC contact, including 156 (21%) with early SPC. Most patients (79%) had late/no SPC. The median time for the first SPC contact was 120 days before death for early SPC group, and 12 days for no/late group, p<0.001. Early SPC group, compared to no/late SPC, had less emergency department contacts (44% vs. 60%, p<0.001) and secondary care hospitalizations (32% vs. 61%, p<0.001) in the last month. Early SPC increased access to hospital-at-home (56% vs. 6%, p<0.001) and SPC wards (19% vs. 4%, p<0.001). Patients with early SPC died more often in SPC wards (19% vs. 4%, p<0.001). Overall, 122 (17%) received hospital-at-home care, and were more likely to die at home (19% vs. 11%, p=0.011) or in SPC wards (15% vs. 5%, p<0.001). Conclusions Few patients with advanced esophageal or gastric cancer receive SPC. Early SPC reduces healthcare utilization and improves access to SPC services, highlighting the importance of timely SPC initiation.