Abstract 1641: Utilization of palliative therapies among Hispanics with stage IV non-small cell lung cancer

Abstract

Abstract Background: Racial disparities in the treatment of lung cancer are well documented. However, research in disparities in palliative care is limited. Early integration of palliative care in advanced non-small cell lung cancer (NSCLC) has been proven to improve quality of life and overall survival in this subset of patients. We proposed to study the use of palliative treatments for stage IV NSCLC among Hispanic patients (pts). Methods: Using the National Cancer Database (NCDB), we identified all Hispanic pts (self-reported) diagnosed with stage IV NSCLC from 2005 to 2013. Cases with incomplete data, unknown life/death status or classified as Hispanic by surname only were excluded. Hispanics were grouped based on place of origin. Pearson chi-square tests were used to estimate differences in categorical data; predictors of palliative care referral/use were determined by logistic regression analysis. Results: 10,441 pts were included. The median age was 66 years. Regarding place of origin: 15.5% of pts were from Mexico, 8% from South/Central America, 7% from Cuba, 6% from Puerto Rico, 2.4% from the Dominican Republic and 57.6% were no-otherwise specified. When all Hispanic pts were included, 3.5% received surgery, 45% radiation and 52.9% chemotherapy. Overall, 2.2% of pts received a referral for palliative pain management +/- other palliative therapies. When divided by place of origin, Dominican pts had the highest percentage of pain management referrals at 5.5% (p<0.01) followed by Puerto Rican patients (2.4%). On the other hand, only 1.3% of pts from South/Central America were referred to pain management. In multivariate analysis, Dominican Republic origin (OR: 3.30, 95%CI: 1.69-6.44, p<0.01), bone metastasis (OR: 1.98, 95%CI: 1.17-3.3, p<0.01) and a Charlson comorbidity index ≥2 (OR: 2.07, 95%CI: 1.11-3.85, p<0.02) were significant predictors of receiving a pain management referral. We observed an increased number of pain management referrals over time with 1.4% of Hispanic patients getting a referral in 2004 vs. 2.9% in 2013 (p<0.02). Conclusions: We observed that only a small percentage of Hispanic pts with metastatic NSCLC cancer are receiving referral for palliative care/pain management. Several cultural beliefs and barriers may play a role in these findings. Providers should offer early referrals to pain management/palliative care to all patients with metastatic NSCLC independent of their race or ethnicity. Citation Format: Narjust Duma, Urshila Durani, Julian Molina, Timothy J. Moynihan. Utilization of palliative therapies among Hispanics with stage IV non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1641.