Palliative Care May Improve EOL Comfort in Early-Onset Colorectal Cancer

The results of a real-world study support palliative care integration in patients with advanced early-onset colorectal cancer.

Palliative care involvement in patients with early-onset colorectal cancer (CRC) may reduce invasive and uncomfortable intervention use, resulting in a subjective improvement in patient end-of-life (EOL) comfort, according to findings from a real-world study presented at the 2025 ASCO Gastrointestinal Cancer Symposium.¹

Data revealed that among patients with early-onset CRC who died during hospitalization, palliative care was associated with significant reductions in multiple invasive interventions. Between 2 cohorts, one treated with palliative care (n = 2425), and another not treated with palliative care (n = 1635), blood transfusion was reported in 14.8% and 22.6% of patients (P <.001), mechanical ventilation was reported in 20.4% and 43.4% of patients (P <.001), and vasopressor use was reported in 6.2% and 8.6%, respectively (P = .004).

Additional data revealed a significant reduction in total charges with palliative care, with a median of $99,367 (SD, 151,864) vs $131,993 (SD, 206,404) without palliative care (P <.001). Furthermore, do not resuscitate (DNR) orders were significantly increased with palliative care, which was reported in 83.3% of this cohort vs 44.6% in patients without palliative care (P < .001).

“Inclusion of palliative care in terminal hospital stays for patients with early-onset CRC was associated with less use of invasive and uncomfortable interventions, resulting in significantly reduced expenditure on futile measures, and likely a subjective improvement in patient [EOL] comfort,” Suriya Baskar, MD, resident physician in the Internal Medicine Department at the Brooklyn Hospital Center, wrote in the study with coinvestigators.¹ “The results of this study support the integration of palliative care in [patients with] early-onset [CRC] presenting with advanced disease.”

The real-world study analyzed admissions in the National Inpatient Sample (NIS) between 2016 and 2020 for patients with a CRC diagnosis younger than 50 who died during admission. Patients on study were identified using ICD-10 codes C18.x, C19.x, and C20.x and stratified based on palliative care consult presence during admission. Patients were assessed based on demographics; Charlson Comorbidity Index (CCI); use of mechanical ventilation, vasopressor, or blood transfusion; length of stay; and total hospital charges.

The median patient age for those who received palliative care was 42.1 ± 6.5 years vs 41.9 ± 6.1 years in those who did not (P = .28). In the respective arms, 44.3% and 39.8% were female (P = .004), and the median CCI scores were 8.6 ± 2.3 and 8.3 ± 2.6, respectively (P <.001).

The mean length of stay was 8.8 ± 10.1 days with palliative care and 9.1 ± 12.7 days without palliative care (P = .38). Additionally, 2.9% and 2.8% of the respective arms received chemotherapy (P = .8).

The study was conducted in the context of prior proven benefits associated with palliative care in elderly patients with advanced cancers, with an identified paucity of data regarding the benefits of palliative care among younger patients with aggressive disease. A study published in JAMA Network Open found that among patients with advanced cancers, those who received early palliative care (n = 73) experienced better quality of life (QOL) at 18 months than those who did not (n = 71; P = .04).²

Furthermore, a greater difference in existential well-being index was observed among patients who received palliative care vs those who did not at 24-week follow-up (0.82 points; 95% CI, 0.03-1.67; P = .05). Additionally, 2-year overall survival was significantly improved among patients who received early palliative care 10 or more times (P < .001).

References

1. Baskar S, Lee BR, Midha R, Grewal US. Impact of inpatient palliative care on end-of-life care among patients with early-onset colorectal cancer. J Clin Oncol. 2025:43(suppl 4):305. doi:10.1200/JCO.2025.43.4_suppl.305
2. Kang E, Kang JH, Koh S-J, et al. Early integrated palliative care in patients with advanced cancer: a randomized clinical trial. JAMA Netw Open. 2024;7(8):e2426304. doi:10.1001/jamanetworkopen.2024.26304