Trends and outcomes of inpatient palliative care use among older Thai patients with pancreatic cancer: a nationwide analysis, 2017-2024.

[BACKGROUND] Pancreatic cancer remains one of the most lethal malignancies worldwide, particularly among older adults with multimorbidity and frailty. Palliative care (PC) is essential for optimizing quality of life and reducing nonbeneficial interventions. This study examined national patterns, trends, and outcomes of inpatient PC use among older adults hospitalized with pancreatic cancer in Thailand.

[METHODS] A retrospective study using the National Health Security Office database from 2017 to 2024, including patients aged ≥ 60 years hospitalized with a primary diagnosis of pancreatic cancer (ICD-10 codes C25.0-C25.7). Inpatient PC utilization was identified using the ICD-10 code Z51.5, recorded at any time during hospitalization. We assessed demographics, hospital type, interventions, costs, and discharge outcomes. Univariate and multivariate logistic regression analyses were performed to examine associations between PC utilization and clinical outcomes, including medical interventions, healthcare costs, and mortality.

[RESULTS] Among 8566 hospital visits, 1045 (12.2%) involved PC. PC recipients were slightly younger, more frequently female, and more likely to be treated at non-Ministry of Public Health hospitals. Across study years, inpatient PC utilization declined in all age groups, most markedly in patients aged 60-69 years. Compared with non-PC patients, those receiving PC had lower rates of chemotherapy (AOR 0.10, 95% CI 0.07-0.13), Whipple surgery (AOR 0.05, 95% CI 0.02-0.12), pancreatectomy (AOR 0.10, 95% CI 0.02-0.40), and biliary interventions (AOR 0.33, 95% CI 0.24-0.44). PC patients had higher odds of blood transfusion (AOR 1.28, 95% CI 1.09-1.49), parenteral nutrition (AOR 1.71, 95% CI 1.09-2.68), prolonged hospital stay (AOR 1.01, 95% CI 1.001-1.02), and in-hospital mortality (AOR 2.89, 95% CI 2.41-3.45). Median hospitalization costs were slightly lower in the PC group (USD 550 vs. 597).

[CONCLUSION] Among older Thai inpatients with pancreatic cancer, PC was utilized in only 12.2% of admissions, with declining trends over time. PC was associated with less aggressive treatment, lower costs, and lower in-hospital mortality, reflecting its potential to reduce nonbeneficial interventions.