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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (5): 996-1001. doi: 10.19723/j.issn.1671-167X.2025.05.027

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Impact of palliative care on medication use and medical utilization in patients with advanced cancer

Dingyi CHEN1, Haoxin DU1, Yichen ZHANG1, Yanfei WANG2, Wei LIU2, Yuanyuan JIAO2, Luwen SHI1,3, Xiaodong GUAN1,3, Xinpu LU2,*()   

  1. 1. Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical sciences, Beijing 100191, China
    2. Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
    3. International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
  • Received:2023-02-20 Online:2025-10-18 Published:2025-09-05
  • Contact: Xinpu LU

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Abstract: Objective: To evaluate the effect of palliative care on drug use, medical service utilization and medical expenditure of patients with advanced cancer. Methods: A cohort of patients including pal-liative care and standard care was constructed using the medical records of the patients in Peking University Cancer Hospital from 2018 to 2020, and coarsened exact matching was used to match the two groups of patients. The average monthly opioid consumption, hospitalization rate, intensive care unit (ICU) rate and operation rate, and the average monthly total cost were selected to evaluate drug use, medical service utilization and medical expenditure. Chi-square test and Wilcoxon signed rank test were used to compare the differences between the two groups before and after exposure and the change in the palliative care group. The net impact of palliative care on the patients was calculated using the difference-in-differences analysis. Results: In this study, 180 patients in the palliative care group and 3 101 patients in the stan-dard care group were finally included in the matching, and the matching effect of the two groups was good (L1 < 0.1). Before and after exposure, the average monthly opioid consumption in the palliative care group was significantly higher than that in the standard care group (Before exposure: 0.3 DDD/person-month vs. 0.1 DDD/person-month, P < 0.01; After exposure: 0.7 DDD/person-month vs. 0.1 DDD/person-month, P < 0.01; DDD refers to defined daily dose), palliative care significantly increased the average monthly opioid consumption in the patients (0.3 DDD/person-month, P < 0.01). The hospitalization rate (48.9% vs. 74.3%, P < 0.01) and operation rate (3.9% vs. 8.8%, P < 0.01) of the patients in palliative care group were significantly lower than those in standard care group, and the ICU rate became similar between the two groups (1.1% vs. 1.6%, P=0.634). Palliative care significantly reduced the patients ' hospitalization rate (-25.6%, P < 0.01), ICU rate (-4.9%, P < 0.01) and operation rate (-14.5%, P < 0.01). Before and after exposure, the average monthly total costs of pal-liative care group were slightly higher than those of standard care group (Before exposure: 20 092.3 yuan vs. 19 132.8 yuan, P=0.725; After exposure: 9 719.8 yuan vs. 8 818.8 yuan, P=0.165). Palliative care increased the average monthly total cost by 2 208.8 yuan, but it was not statistically significant (P=0.316). Conclusion: Palliative care can increase the opioid consumption in advanced cancer patients, reduce the rates of hospitalization, ICU and surgery, but has no significant effect on medical expenditure.

Key words: Palliative care, Neoplasm, Opium, Drug utilization, Medical service utilization, Medical expenditure

CLC Number: 

  • R730.5

Figure 1

Flow chart of patient inclusion, exclusion, assignment and matching"

Figure 2

Each time point and period in the study PC, palliative care; SC, standard care."

Table 1

Characteristics of patients in the palliative care group and the standard care group"

Items Palliative care group (n=180) Standard care group (n=3 101) L1
Sex ＜0.01
    Female 55 (30.6) 1 198 (38.6)
    Male 125 (69.4) 1 903 (61.4)
Age/years 0.013
    18-44 8 (4.4) 54 (1.7)
    45-64 75 (41.8) 1 308 (42.2)
    ≥65 97 (53.9) 1 739 (56.1)
Location of medical insurance 0.046
    Local 42 (23.3) 578 (18.6)
    Non-local 138 (76.7) 2 523 (81.4)
Year of diagnosis 0.072
    2011-2015 13 (7.2) 30 (1.0)
    2016-2020 167 (92.8) 3 071 (99.0)
Cancer site 0.044
    Digestive system 80 (44.4) 984 (31.7)
    Respiratory system 19 (10.6) 242 (7.8)
    Genital system 1 (0.6) 3 (0.1)
    Hematologic system 1 (0.6) 259 (8.4)
    Breast 5 (2.8) 13 (0.4)
    Head and neck 6 (3.3) 7 (0.2)
    Other sites 6 (3.3) 9 (0.3)
    Not specified 62 (34.4) 1 584 (51.1)

Table 2

Comparison of each outcome in the two groups before and after exposure"

Outcomes Before exposure After exposure
Palliative care group Standard care group P Palliative care group Standard care group P
Drug use
  Average monthly opioid consumption/DDD per person-month 0.3 0.1 ＜0.01 0.7* 0.1 ＜0.01
Medical service utilization
  Hospital rate/% 100.0 99.8 0.555 48.9* 74.3 ＜0.01
  ICU rate/% 6.7 2.3 ＜0.01 1.1* 1.6 0.634
  Operation rate/% 25.6 15.1 ＜0.01 3.9* 8.8 ＜0.01
Medical expenditure
  Average monthly total cost/yuan 20 092.3 19 132.8 0.725 9 719.8 8 818.8 0.165

Table 3

The net effect value of palliative care on each outcome"

Outcomes Net effect value |t| P
Drug use
    Average monthly opioid consumption/DDD per person-month 0.3 4.48 ＜0.01
Medical service utilization
    Hospital rate/% -25.6 4.53 ＜0.01
    ICU rate/% -4.9 3.17 ＜0.01
    Operation rate/% -14.5 4.02 ＜0.01
Medical expenditure
    Average monthly total cost/yuan 2 208.8 1.00 0.316
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