ASPO Abstracts
Health Care Access Measures Associated with Palliative Care Use Among Gynecological Cancer Patients: an analysis of the 2016 National Cancer Database
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Background: Palliative care can improve quality-of-life and extend survival of cancer patients, however, it is
underutilized. Our objective was to evaluate the associations between healthcare access (HCA) measures and
palliative care utilization among gynecological cancer patients.
Methods: We used data from the 2016 National Cancer Database and included patients with metastatic (stage III-IV at
diagnosis) ovarian, cervical, and uterine cancer patients deceased at last follow-up (n=124,729). Palliative care was
defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management or any
combination. HCA measures examined include insurance type, distance-to-care, and cancer treatment facility type.
We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable
logistic regression.
Results: The majority were non-Hispanic (NH)-White (74%), ovarian cancer patients (74%), and 24% survived less
than 6 months. Only 5% of deceased patients with ovarian, 11% with cervical, and 12% with uterine metastatic cancer
utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR:1.62, 95%
CI:1.35-1.94) and cervical (aOR:1.41, 95% CI:1.21-1.64) cancer were more likely to use palliative care. Medicaid
insured patients with ovarian cancer (aOR: 1.83, 95% CI:1.56-2.14) and cervical cancer (aOR: 1.35, 95% CI:1.20-1.52)
were more likely to utilize palliative care. Patients with ovarian (aOR:0.59, 95% CI:0.49-0.72) or cervical cancer
(aOR:0.79, 95% CI:0.65-0.97) who reside over 45 miles from their provider were less likely to utilize palliative care
than patients living within <2 miles. Compared to ovarian cancer patients treated at comprehensive community cancer
programs, patients treated at academic/research programs were less likely to utilize palliative care (aOR: 0.73, 95%
CI: 0.60-0.88). When stratified by race/ethnicity, the associations between HCA measures and palliative care utilization
were largely consistent.
Conclusion: Palliative care is underutilized among metastatic gynecologic cancer patients. Insurance type and distance
from provider to patient may influence palliative care use among metastatic gynecological cancer patients.
Keywords: Racial disparities, gynecologic cancers, health care access, insurance type, distance-to-care