Impact of palliative care integration on end-of-life resource utilization and costs in oncology patients: a single-center analysis in Jordan

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Abstract
Introduction: Evidence from Middle Eastern cancer centers on the impact of palliative care on end-of-life practices remains limited. This study evaluated healthcare utilization, diagnostic costs, and timing of palliative care referral requests at a tertiary cancer center in Jordan. Materials and methods: We conducted a retrospective cohort study including all 299 adult cancer patients who died between February 2017 and May 2018. Patients were categorized based on the clinical service responsible at death (oncology vs. palliative care). Demographic and clinical characteristics, reasons for final hospitalization, and costs of laboratory and radiologic exams performed in the last seven days of life were extracted. Descriptive and univariate analyses were performed. Results: Of 299 patients, 151 (50.5%) were managed by palliative care at death. The mean (SD) age was 57.1 ± 14.3 years. The most common reasons for final admission were decreased level of consciousness 60 (20.1%) and pain crisis 57 (19.1%). Among the 148 oncology patients, 43 (29.1%) had documented palliative care referral requests but remained under oncology care at the time death. In the last seven days of life, 1,623 diagnostic exams were performed at a total cost of 186,572 USD. Oncology-managed patients had higher diagnostic intensity and costs compared to palliative patients (mean cost 856.58 vs. 397.38 USD; mean exams 6.6 vs. 4.2; both p < 0.001). Exams were performed closer to death in oncology patients (mean 0.39 vs. 2.92 days; p < 0.001). Referral requests were associated with longer referral-to-death intervals (median 14 vs. 1 day; p < 0.001). Discussion: Palliative care involvement was associated with lower diagnostic intensity and costs at end of life. However, referral requests were often late or not translated into active palliative management. Earlier and more consistent integration of palliative care may improve resource utilization and align care with patient-centered goals.

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