Palliative Care May Reduce Invasive Intervention Use in Early-Onset CRC

Palliative care in young adults with early-onset colorectal cancer reduced invasive procedures, costs and increased DNR orders, improving end-of-life comfort.

Among patients with early-onset colorectal cancer (CRC), palliative care involvement 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.

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 two cohorts, one treated with palliative care (2,425 patients), and another not treated with palliative care (1,635 patients), blood transfusion was reported in 14.8% and 22.6% of patients, mechanical ventilation was reported in 20.4% and 43.4% of patients and vasopressor use was reported in 6.2% and 8.6%, respectively.

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

“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,” Dr. Suriya Baskar, resident physician in the Internal Medicine Department at the Brooklyn Hospital Center, wrote in the study with coinvestigators. “The results of this study support the integration of palliative care in [patients with] early-onset [CRC] presenting with advanced disease.”

According to the National Cancer Institute’s website, palliative care aims to improve quality of life and reduce pain for individuals with serious or life-threatening illnesses, such as cancer. The goal is to prevent or treat disease symptoms and treatment side effects as early as possible. This care also addresses the psychological, social and spiritual issues arising from the illness or its treatment. For patients with cancer, palliative care can include therapies like surgery, radiation or chemotherapy to remove, shrink or slow tumor growth causing pain. It may also involve support for family and caregivers. Palliative care can be provided alongside other treatments from diagnosis to end of life.

The median age of patients receiving palliative care was 42.1 years compared to 41.9 years for those not receiving such care. Women made up 44.3% of the palliative care group and 39.8% of the group that did not receive palliative care.

The mean length of hospital stay was 8.8 days for patients receiving palliative care and 9.1 days for those who did not. Chemotherapy was administered to 2.9% of the palliative care group and 2.8% of the other group.

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 (73 patients) experienced better quality of life (QOL) at 18 months than those who did not (71 patients).

Furthermore, a greater difference in existential well-being index was observed among patients who received palliative care versus those who did not at 24-week follow-up (0.82 points). Additionally, two-year overall survival was significantly improved among patients who received early palliative care 10 or more times.

Reference:

"Impact of inpatient palliative care on end-of-life care among patients with early-onset colorectal cancer" by Dr. Suriya Baskar, et al., J Clin Oncol.

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