Survival and cost analysis of early palliative care referral in pancreatic cancer: A single-center retrospective study.

312 Background: Pancreatic cancer causes substantial physical, psychosocial, and financial stress. Limited data exists on optimal timing of palliative care referral (PCR) in the course of pancreatic cancer. We propose that early PCR alleviates symptom burden, improves quality of life (QOL), reduces healthcare utilization (HCU) costs, and improves overall survival (OS) in pancreatic cancer. Methods: We conducted a single center retrospective study for pancreatic cancer patients from January 2015-January 2024. Patients were stratified based on PCR timing from diagnosis, into early PCR (<3 months), and late PCR (≥3 months) cohorts. We assessed emergency department (ED) visits and hospital and intensive care unit (ICU) admissions, using Mann-Whitney U test. OS was compared using cox-regression and Kaplan-Meier curve. In a subset with Highmark (HM) insurance, we evaluated differences in per-member per month (PMPM) costs as a function of PCR timing, using generalized linear models with negative binomial distribution. Results: Among 250 pancreatic cancer patients with a PCR (147 early PCR, 103 late PCR), 137 patients (54.8%) had stage 4 disease, with 62.6% patients in early PCR cohort and 53.7% patients in late PCR cohort. Early PCR was associated with significantly lower (p<0.0001) ED visits versus (V/S) late PCR, 2 [Interquartile range (INR)1-3] v/s 3(INR 2-5), hospital admissions, 2 (INR 1-3), v/s 3 (INR 2-5), and ICU admissions, 0 (INR 0-1), v/s 1 (INR 1-2). Chemotherapy use in last 2 months was observed in 33.0% patients with late PCR and 32.0% patients with early PCR, but the difference was statistically insignificant, p=0.86. However, patients in early PCR cohort had worse OS than those with late PCR, HR = 2.04, p < .0001. 150 patients had Highmark insurance. At shorter follow up durations, 3 and 6 months, early PCR group had significantly higher PMPM spending, compared to late PCR. However, at 12 and 24 months, PMPM costs were similar among both groups (table 1). Conclusions: Early PCR reduces aggressive care towards end of life, which helps improve patients’ QOL. Early PCR may be associated with higher short-term costs due to proximity to death, but it does not increase and may even reduce long-term healthcare costs. However, survival benefit could not be demonstrated, perhaps due to the aggressive nature of pancreatic cancer. Further research should evaluate the impact on patient and caregiver-reported outcomes. Differences in predicted PMPM across those with late versus early PCR. Contrast Follow-up duration (months) Estimate Standard error z statistic p value Late - Early 3 -9090.35 3366.91 -2.70 0.03 Late - Early 6 -5327.89 2233.64 -2.39 0.05 Late - Early 12 -934.45 1422.93 -0.66 0.51 Late - Early 24 1786.58 950.18 1.88 0.12