Palliative care utilization among adults hospitalized with metastatic gastrointestinal malignancies in the United States, 2016 to 2022: national trends, cancer-type variation, and predictors of consultation

Background Palliative care (PC) is integral to goal-concordant care for patients with advanced cancer, yet inpatient consultation remains inconsistently utilized. Contemporary national data on cancer-specific differences and factors associated with PC utilization in metastatic gastrointestinal (GI) malignancies are limited. Methods We conducted a cross-sectional study of adult hospitalizations (2016-2022) from the National Inpatient Sample, identifying metastatic GI cancers using ICD-10 codes and PC consultation by code Z51.5. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) controlling for demographics, cancer type, comorbidity, and hospital characteristics. Prespecified models were fitted for hepatocellular carcinoma (HCC) and colorectal cancer (CRC). Secular trends were quantified using joinpoint regression. Results Overall, 20.6% of hospitalizations involved PC consultation, rising from 19.2% (2016) to 23.9% (2022; annual percentage change 3.47%, P < 0.001). Rates ranged from 17.0% (CRC) to 32.1% (HCC). Compared with CRC, odds of PC were significantly higher for HCC (aOR 3.98), cholangiocarcinoma (aOR 2.63), pancreatic cancer (aOR 2.61), esophageal cancer (aOR 2.33), and gallbladder cancer (aOR 1.78; all P < 0.001). Black adults had higher odds than White adults (aOR 1.17). Medicare (aOR 0.70) and private insurance (aOR 0.80) had lower odds compared with Medicaid. Urban hospitals had higher utilization than rural hospitals. Higher comorbidity burden demonstrated a stepwise association with increased PC use. Cancer-specific models revealed distinct demographic and institutional predictors for CRC and HCC. Conclusions Inpatient PC for metastatic GI cancers remains underutilized, with wide variation by cancer type, insurance, region, and hospital characteristics, underscoring the need for structured, diagnosis-specific consultation pathways.