Use of inpatient palliative care in metastatic testicular cancer patients undergoing critical care therapy: insights from the national inpatient sample

Cristina Cano Garcia; Reha-Baris Incesu; Francesco Barletta; Simone Morra; Lukas Scheipner; Andrea Baudo; Stefano Tappero; Mattia Luca Piccinelli; Zhe Tian; Fred Saad; Shahrokh F Shariat; Carlo Terrone; Ottavio De Cobelli; Luca Carmignani; Sascha Ahyai; Nicola Longo; Derya Tilki; Alberto Briganti; Severine Banek; Luis A Kluth; Felix K H Chun; Pierre I Karakiewicz

doi:10.1038/s41598-024-83545-7

Use of inpatient palliative care in metastatic testicular cancer patients undergoing critical care therapy: insights from the national inpatient sample

Sci Rep. 2025 Jan 6;15(1):967. doi: 10.1038/s41598-024-83545-7.

Authors

Cristina Cano Garcia^{1

2}, Reha-Baris Incesu^{3

4}, Francesco Barletta^{3

5

6}, Simone Morra^{3

7}, Lukas Scheipner^{3

8}, Andrea Baudo^{3

9

10}, Stefano Tappero^{3

11

12}, Mattia Luca Piccinelli^{3

13}, Zhe Tian³, Fred Saad³, Shahrokh F Shariat^{14

15

16

17}, Carlo Terrone^{11

12}, Ottavio De Cobelli¹³, Luca Carmignani^{9

10}, Sascha Ahyai⁸, Nicola Longo⁷, Derya Tilki^{4

18

19}, Alberto Briganti^{5

6}, Severine Banek²⁰, Luis A Kluth²⁰, Felix K H Chun²⁰, Pierre I Karakiewicz³

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada. [email protected].
² Department of Urology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany. [email protected].
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
⁴ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁵ Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Vita-Salute San Raffaele University, Milan, Italy.
⁷ Reproductive Sciences and Odontostomatology, Urology Unit, Department of Neurosciences, University of Naples Federico II, Naples, Italy.
⁸ Department of Urology, Medical University of Graz, Graz, Austria.
⁹ Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
¹⁰ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
¹¹ Department of Urology, Ospedale Policlinico San Martino, Genoa, Italy.
¹² Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy.
¹³ Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
¹⁴ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁵ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁶ Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
¹⁷ Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁸ Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ Department of Urology, Koc University Hospital, Istanbul, Turkey.
²⁰ Department of Urology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany.

Abstract

To test for rates of inpatient palliative care (IPC) in metastatic testicular cancer patients receiving critical care therapy (CCT). Within the Nationwide Inpatient Sample (NIS) database (2008-2019), we tabulated IPC rates in metastatic testicular cancer patients receiving CCT, namely invasive mechanical ventilation (IMV), percutaneous endoscopic gastrostomy tube (PEG), dialysis for acute kidney failure (AKF), total parenteral nutrition (TPN) or tracheostomy. Univariable and multivariable logistic regression models addressing IPC were fitted. Of 420 metastatic testicular cancer patients undergoing CCT, 70 (17%) received IPC. Between 2008 and 2019, the rates of IPC among metastatic testicular cancer patients undergoing CCT increased from 5 to 19%, with the highest rate of 30% in 2018 (EAPC: + 9.5%; 95% CI + 4.7 to + 15.2%; p = 0.005). IPC patients were older (35 vs. 31 years, p = 0.01), more frequently had do not resuscitate (DNR) status (34 vs. 4%, p < 0.001), more frequently exhibited brain metastases (29 vs. 17%, p = 0.03), were more frequently treated with IMV (76 vs. 53%, p < 0.001) and exhibited higher rate of inpatient mortality (74 vs. 29%, p < 0.001). In multivariable analyses, DNR status (OR 10.23, p < 0.001) and African American race/ethnicity (OR 4.69, p = 0.003) were identified as independent predictors of higher IPC use. We observed a significant increase in rates of IPC use in metastatic testicular cancer patients receiving CCT, rising from 5 to 19% between 2008 and 2019. However, this rates remain lower compared to metastatic lung cancer patients, indicating the need for further awareness among clinicians treating metastatic testicular cancer. The increase in IPC rates for metastatic testicular cancer patients receiving CCT indicates a need for ongoing education and awareness among healthcare providers. This could enhance the integration of IPC in the treatment of advanced cancer, potentially improving quality of life and care outcomes for survivors.

Keywords: Critical care therapy; End-of-life care; Inpatient palliative care; Metastatic testicular cancer; NIS.

MeSH terms

Adult
Aged
Critical Care* / statistics & numerical data
Humans
Inpatients* / statistics & numerical data
Male
Middle Aged
Neoplasm Metastasis
Palliative Care*
Testicular Neoplasms* / pathology
Testicular Neoplasms* / therapy
United States / epidemiology