ASPO Abstracts
Prevalence of Palliative Care Use and Associated Characteristics among Patients with Stage-IV Breast Cancer – National Cancer Database, 2004-2019
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: To estimate the prevalence of palliative care (PC) use and examine associated demographic and clinical characteristics among stage-IV breast cancer patients (pts). Methods: Data came from the 2004-2019 National Cancer Database (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and American Cancer Society. Per NCDB, PC, including surgery, radiotherapy, systemic therapy, and/or other pain management, was performed to alleviate symptoms; use was dichotomized as yes/no. Multivariable logistic regression was used to assess the associations between PC use and demographic and clinical characteristics. Results: Of 137,702 pts (mean age 62 [SD 14] years), 72.6% were White, followed by 16.9% Black, 5.8% Hispanic, and 2.7% Asian; 53.0% were on Medicaid/Medicare and 38.8% had private insurance; 61.4% and 10.4% had ductal and lobular carcinoma, respectively; 61.4% were HR+/HER2–. PC use increased annually during 2004-2019, with an overall 20.2% prevalence. We observed significant differences in race/ethnicity, insurance type, distance to care, Charlson-Deyo comorbidity index (CCI), histologic type, molecular subtype, and receipt of hormone therapy or chemotherapy by PC use. In the adjusted model, Black (adjusted odds ratio [aOR] 0.89, 95% CI 0.85-0.94), Asian (aOR 0.79, 95% CI 0.71-0.88), and Hispanic (aOR 0.67, 95% CI 0.61-0.73) pts had lower odds of PC use than White pts. A CCI of 1 (aOR 1.08, 95% CI 1.02-1.13) or ≥2 (aOR 1.24, 95% CI 1.15-1.33) was associated with greater odds of PC use. Compared to Pts with private insurance, those on Medicaid had greater odds of PC use (aOR 1.11, 95% CI 1.05-1.18) while those on Medicare had lower odds (aOR 0.95, 95% CI 0.91-0.99). Pts who received hormone therapy (aOR 1.43, 95% CI 1.36-1.49) or chemotherapy (aOR 1.05, 95% CI 1.01-1.09) had greater odds of PC use than those who did not. Conclusions: PC use was low among stage-IV breast cancer pts. Demographic and clinical characteristics were independently associated with PC use. Racial/ethnic minorities were less likely to have used PC. Our findings suggest that pts with comorbidities or who received systemic treatment may be in greater need of PC and strategies promoting PC use in racial/ethnic minorities may be needed.
Keywords: palliative care use, racial/ethnic minorities, breast cancer, NCDB