Michelle R Ju1, Subhadeep Paul2, Patricio Polanco1, Mathew Augustine1, John Mansour1, Sam Wang1, Matthew R Porembka3. 1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA. 2. School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 3. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA. matthew.porembka@utsouthwestern.edu.
Abstract
BACKGROUND: Metastatic foregut cancers (MFC) are associated with debilitating symptoms that negatively impact patients' quality of life. Palliative care (PC) is effective in mitigating disease-, psychosocial-, and treatment-related effects and may improve survival in select cases. Our study characterizes PC utilization rates in MFC and identifies factors associated with PC receipt. METHODS: We conducted a retrospective review of 228,027 National Cancer Database patients diagnosed with MFC between 2004 and 2016. Chi-squared tests were used to analyze differences between groups receiving and not receiving PC. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC. RESULTS: Overall PC utilization was low (17.8%). A greater proportion of patients not receiving PC were in the lowest median income quartile of < $38,000/year versus those receiving PC (18.1% vs 17.8%, p < 0.0001). Higher education was associated with increased likelihood of receiving PC (OR 1.23 for communities with < 6.3% no high school degree vs ≥ 17.6%, p < 0.0001). Hispanics were significantly less likely to receive PC compared to Whites (OR 0.72, 95% CI 0.68-0.76). Patients treated at academic centers were also more likely to receive PC compared to those treated in the community (OR 1.10, 95% CI 1.05-1.14). CONCLUSIONS: PC is a key component in improving quality of life among MFC patients. Despite slight increases in PC rates over time, PC remains drastically underutilized. Significant racial and socioeconomic disparities in patterns of PC delivery exist. Further studies are needed to understand these disparities in order to identify key targets for interventions aimed at improving equity.
BACKGROUND: Metastatic foregut cancers (MFC) are associated with debilitating symptoms that negatively impact patients' quality of life. Palliative care (PC) is effective in mitigating disease-, psychosocial-, and treatment-related effects and may improve survival in select cases. Our study characterizes PC utilization rates in MFC and identifies factors associated with PC receipt. METHODS: We conducted a retrospective review of 228,027 National Cancer Database patients diagnosed with MFC between 2004 and 2016. Chi-squared tests were used to analyze differences between groups receiving and not receiving PC. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC. RESULTS: Overall PC utilization was low (17.8%). A greater proportion of patients not receiving PC were in the lowest median income quartile of < $38,000/year versus those receiving PC (18.1% vs 17.8%, p < 0.0001). Higher education was associated with increased likelihood of receiving PC (OR 1.23 for communities with < 6.3% no high school degree vs ≥ 17.6%, p < 0.0001). Hispanics were significantly less likely to receive PC compared to Whites (OR 0.72, 95% CI 0.68-0.76). Patients treated at academic centers were also more likely to receive PC compared to those treated in the community (OR 1.10, 95% CI 1.05-1.14). CONCLUSIONS: PC is a key component in improving quality of life among MFC patients. Despite slight increases in PC rates over time, PC remains drastically underutilized. Significant racial and socioeconomic disparities in patterns of PC delivery exist. Further studies are needed to understand these disparities in order to identify key targets for interventions aimed at improving equity.
Authors: Marie Bakitas; Kathleen Doyle Lyons; Mark T Hegel; Stefan Balan; Frances C Brokaw; Janette Seville; Jay G Hull; Zhongze Li; Tor D Tosteson; Ira R Byock; Tim A Ahles Journal: JAMA Date: 2009-08-19 Impact factor: 56.272
Authors: Hamza Khan; Deepa Cherla; Krista Mehari; Manish Tripathi; Thomas W Butler; Errol D Crook; Martin J Heslin; Fabian M Johnston; Annabelle L Fonseca Journal: Ann Surg Oncol Date: 2022-09-28 Impact factor: 4.339