829 Background: Gastrointestinal (GI) cancer accounts for nearly 20% of all cancer cases in the United States. The incidence of GI cancer is rising among patients under 40. Young adults with cancer face unique challenges, particularly at the end of life (EOL), including complex treatment decisions and significant psychosocial distress. While palliative care has been shown to improve symptom management and facilitate early discussions regarding treatment trajectories among patients with cancer, its impact on acute care utilization at the EOL among young adults with GI cancers is less known. Methods: We conducted a retrospective study of patients 18-40 years of age with advanced GI cancers who died between 2019-2024 at a single academic center and its affiliated community centers. Primary outcome was acute care use in the last 30 days of life (defined as ED/hospital admissions, ICU admission, intubation, CPR, death in the hospital, and systemic cancer-directed therapy use). Additionally, we collected information on hospice referrals and advanced care planning (ACP). Fisher’s exact test and Pearson’s Chi Square-test were used to determine the association between outpatient palliative care and acute care use at the EOL. The study protocol was written prior to data collection. It was determined to be non-human subjects research and did not require IRB review per institution guidelines. Results: Among the 155 young adults with GI cancers who died from 2019-2024, the median age at diagnosis was 34 years, 85 (55%) were male, 100 (65%) were non-Hispanic White, 98 (63%) had commercial insurance, and most had colorectal cancer (n = 76, 49%). Of the 155 patients, 75 (48%) had at least one outpatient palliative care visit prior to death. Those who had a palliative care visit were more likely to have completed ACP (p < 0.001) although had no difference in hospice referrals. Additionally, only 31 of 75 (41%) patients had their first palliative care visit six months or more prior to death. There was no statistically significant difference in acute care usage among patients with or without outpatient palliative care visits. Conclusions: Palliative care remains infrequently integrated into the cancer care of young adults with advanced GI cancer. Despite more documented ACP, outpatient palliative care visits were not associated with reduced acute care use at the EOL. These findings may reflect the unique values within this younger population at the EOL and the role palliative care may contribute in supporting those decisions. However, this ongoing interplay requires further investigation to ensure the continued receipt of patient-centered care.
Patel et al. (Sat,) studied this question.