E394: Advanced Care Planning Prior to Oncologic Surgery: An Assessment of Utilization and Implications

With the shift towards value-based cancer care, Advanced Care Planning (ACP) can improve outcomes and reduce costs to patients. However, its utilization and implications in the perioperative setting are unknown.  This study evaluates the use of perioperative ACP within an integrated cancer network.

Methods: We analyzed patients who underwent potentially curable oncologic surgery within a regional health system from January, 2015 to December, 2021. Using claims data, the amount paid on a per-member per-month basis was used to define health care utilization. We identified patients who had ACP based on procedural codes indicative of formal ACP. Patients were categorized by the timing of ACP: preoperative (Preop-ACP), postoperative (Postop-ACP), or none. To evaluate the potential value implications of ACP, logistic regression-based propensity scores were used to match a cohort of breast cancer patients, and the total 30-day postoperative healthcare utilization was compared.

Results: Of 5,415 cancer patients who underwent surgery, 452 (8.4%) received ACP, of which 70 received Preop-ACP, and 382 received Postop-ACP. Patients who received ACP were 73±10 years, 98% white, and 61% female. Of all patients over the age of 80 years (n=623), 26% received ACP. Of those with a Charlson Comorbidity Index > 2 (n=70), 34% received ACP. The highest ACP utilization was seen in patients with liver (n=47, 35%) and lung (n=183, 29%) cancer; see figure. Of all patients with advanced stage disease (clinical stage III or higher; n=556), 30% received ACP. Of those who received Preop-ACP, breast cancer patients represented the highest utilization (n=25, 36%). To assess the implications of ACP, 20 Preop-ACP breast cancer patients were matched with 20 breast cancer patients having either Postop-ACP or no ACP. With similar rates between matched cohorts, 85% underwent breast conservation surgery. Total 30-day healthcare utilization was $7,392.49 ($5,437.88 - $11,443.68) for Preop-ACP vs $10,484.47 ($6,085.74 - $15,825.05) for Post-ACP, p=0.984.

Conclusions: Despite the known benefits of ACP for cancer patients, it is rarely utilized in the perioperative setting. Given the opportunity for patient-centric, goal-directed care and a potential reduction in healthcare costs, a deeper exploration of the implications of ACP in the preoperative setting is warranted.