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PPS45. Inpatient palliative care and procedural intensity in patients with hepatopancreatobiliary cancers at the end of life

Friday, March 6, 2026
3:40 PM - 4:10 PM MST
Location: HUB Poster Park - West Hall 1-3
Introduction

Hepatopancreatobiliary (HPB) malignancies are among the most aggressive and morbid solid tumors. They are associated with frequent invasive interventions near the end of life, even though high-intensity, aggressive end-of-life care may be associated with poorer perceived quality of care. Although national guidelines emphasize early palliative care integration to improve quality of life and facilitate goal-concordant care, its optimal role for patients with complex HPB malignancies at the end of life and in the inpatient setting remains poorly understood.

Methods

We performed a retrospective analysis of patients with HPB cancers admitted within six months of death from 2013-2024 at a single institution. Patients were categorized according to whether they underwent inpatient interventions and further stratified by timing of the procedure—within one month or between one and six months of death. We examined temporal trends in inpatient palliative care consultations and evaluated how palliative care involvement might influence procedural intensity at the end of life.

Results

Among 3,073 patients, 1,510 (49%) underwent an inpatient procedure within six months of death, including 635 (21%) in the last month of life. Median length of stay was longer among those who underwent procedures (7 vs. 5 days, p<0.0001), while in-hospital death was more frequent among those who did not (21% vs. 14%, p<0.0001). Inpatient palliative care consultations increased over the study period across both groups. However, among patients undergoing procedures, consults were significantly less frequent in the final month of life. Patients who had procedures within the last month were more likely to receive palliative care than those who had procedures earlier (40% vs. 29%, p<0.0001). Nearly two-thirds of patients across both procedure groups received palliative care consults after all inpatient procedures. When palliative care was involved prior to procedures, patients were more likely to undergo palliative rather than curative or exploratory operations (p=0.03). Earlier palliative care involvement was also associated with fewer operative and more percutaneous interventions (p=0.02).

Conclusions

Invasive interventions at the end of life remain common among patients with HPB cancers. Although inpatient palliative care use has increased, consultation occurs late, frequently after procedures have already been performed. Earlier palliative care involvement may guide treatment towards less aggressive, more goal-concordant care, improving end-of-life experiences.

Learning Objectives:

  • Understand the prevalence of inpatient procedures for patients with HPB cancers nearing the end of life.
  • Recognize that despite increasing palliative care utilization over the study period, inpatient consultation remains low among patients with HPB cancers at the end of life.
  • Appreciate how inpatient palliative care involvement, and the timing of consultation, influences the inpatient procedures patients with HPB cancers undergo at the end of life.