Abstract 746: Disparities in factors affecting access to palliative care in patients with stage IV breast cancer

Abstract

Abstract Background: Palliative care is an essential component of cancer care; however, factors hindering its reach to the target population remain understudied. We aim to explore whether an association exists between socioeconomic and geographic factors and access to palliative care (PC) in patients with Stage IV breast cancer in the US. Methods: This 2004-2017 National Cancer Database analysis includes patients with Stage IV breast cancer who received palliative care. Access to PC is defined as being either at the patient’s primary healthcare facility or at a referral site. Chi-square tests and a multivariate logistic regression were performed to determine the independent factors predicting access to PC. SAS version 9.4 was used to analyze the data. Results: A total of 18,903 patients were included in the analysis: 15,111 received palliative care services at the same facility and 3,792 were referred elsewhere. Patient age, race, insurance status, Charlson-Deyo score, setting, high school diploma status, median income, facility type, facility location, and distance from healthcare centers were all significantly different between the two groups. On logistic regression, better odds for access to PC were predicted by urban settings (OR: 1.47; 95% CI: 1.30 - 1.67) and being in the Middle Atlantic region (OR: 1.27; 95% CI: 1.07 - 1.52). Distance from the healthcare facility of 4 miles or greater predicted worse odds for access to PC. Comprehensive cancer programs (OR: 1.60; 95% CI: 1.43 - 1.80) and academic/research programs (OR: 2.40; 95% CI: 2.11 - 2.73) held higher odds for access to PC. Having Medicaid/other government insurance (OR: 1.43; 95% CI: 1.24 - 1.65) predicted better odds for access to PC. However, having no insurance was also found to increase access to PC (OR: 1.30; 95% CI: 1.08 - 1.55). Median income and high school diploma status were not significantly associated with the outcome. Conclusion: PC was positively affected by having access to urban settings, nearby healthcare centers, non-community care centers, Medicaid/other governmental insurance, and by being in the Middle Atlantic region of the US. Having no insurance appears to increase palliative care use, which was unexpected but could be explained if patients with no insurance did not receive standard treatment and were instead offered palliative care. This needs to be investigated in future research. Citation Format: Mira Itani, Saad Sabbagh, Mohamed Mohanna, Barbara Dominguez, Hong Liang, Zeina Nahleh. Disparities in factors affecting access to palliative care in patients with stage IV breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 746.