Background: Rates and patterns of inpatient palliative care (IPC) use in metastatic upper urinary tract carcinoma (mUTC) are largely unknown.
Objectives: To assess temporal trends and predictors of IPC in patients with mUTC.
Design: Relying on the National Inpatient Sample (2008-2019), we identified 3563 mUTC United States inpatients.
Methods: Estimated annual percentage changes (EAPC) analyses as well as logistic regression models addressing IPC use were fitted. Subgroup analyses addressed IPC use according to the number and location of metastatic sites.
Results: Of 3563 mUTC inpatients, 540 (15%) received IPC. Overall, the rate of IPC increased from 2 to 22% between 2008 and 2019 (EAPC +10%). In subgroup analyses, the highest increase in IPC use was observed in patients with liver metastases (from 3 to 33%; EAPC + 11%), in patients with bone metastases (from 3 to 29%; EAPC: +10%), and in patients with three or more metastatic sites (from 0.5 to 31%; EAPC: 10%; all p ⩽ 0.003). In multivariable logistic regression models, liver metastases (odds ratio (OR) 1.91, 95% confidence interval (CI) 1.53-2.39), bone metastases (OR 1.83, 95% CI 1.46-2.28), and contemporary year of admission (OR 1.93, 1.57-2.38; all p < 0.001) independently predicted higher IPC rates. Limitations include the retrospective nature of the inpatient database.
Conclusion: The IPC rate in mUTC was very low (15%). However, this rate increased to approximately 22% in 2019. The highest IPC rates were recorded in contemporary liver (33%), bone (29%), and three or more metastatic sites (31%) United States inpatients. Therefore, clinicians should be sensitized to early IPC use in mUTC patients in general as well as in other metastatic distribution patterns.
Keywords: NIS; UTUC; in-hospital mortality; metastatic stage; palliative care.
Patterns of inpatient palliative care use in patients with metastatic upper urinary tract carcinoma within the United States Why was the study done? Early implementation of palliative care in cancer treatment represents a well-established guideline recommendation for patients with advanced cancers. However, patterns of inpatient palliative care use in patients with metastatic upper urinary tract carcinoma are largely unknown. What did the researchers do? The research team examined temporal trends and predictors of palliative care use among inpatients with metastatic upper tract urinary tract carcinoma in the United States between 2008 and 2019. What did the researchers find? Of 3563 United States inpatients with metastatic upper urinary tract carcinoma, only a minority of 15% received inpatient palliative care. Between 2008 and 2019, the rate of inpatient palliative care significantly increased from 2 to 22%. In particular, the highest average annual increase in inpatient palliative care use was observed in inpatients with multiple metastases as well as those with bone or liver metastases. Even after accounting for other clinical and tumor characteristics, liver metastases, bone metastases, and contemporary years of admission were associated with use of inpatient palliative care. What do the findings mean? In the United States, inpatient palliative care use in metastatic upper urinary tract carcinoma was very low. Moreover, this study identified important differences in inpatient palliative care use according to the number as well as the location of metastatic sites. In consequence, the current observations validate the need to sensitize clinicians towards guideline-recommended implementation of inpatient palliative care use, regardless of the number and location of metastatic sites.
© The Author(s) 2026.