Abstract C006: Underutilization of palliative care in metastatic foregut cancer patients is associated with socioeconomic disparities

Abstract

Abstract Introduction: Metastatic cancers of the foregut are frequently associated with debilitating symptoms that negatively impact quality of life. We aim to determine the rate of palliative care (PC) use in metastatic neoplasms of the foregut and the factors which are associated with receipt of PC. Methods: Using the National Cancer Database (NCDB), patients with metastatic cancers of the foregut were selected. Receipt of PC as defined by the NCDB participant use file was correlated to demographic and clinicopathologic factors. PC treatment included surgery, radiation, systemic therapy, and pain management to alleviate symptoms. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Results: Between 2004 and 2013, 277957 patients with metastatic foregut cancers (MFC) including gastric (42626, 15.3%), pancreas (109219, 39.2%), bile duct (8890, 3.2%), gall bladder (10058, 3.6%) and esophagus cancer (107164, 38.6%) were identified. Median age was 66 years (IQR: 55-76 years) and 64% were male. Among all cancer types, PC utilization was 14.7% (40787). PC utilization increased over time (2004-6 12.3%, 2007-10 14.7%, 2011-13 16.4%; p<0.001). PC utilization was different between cancer types [gastric 6965 (16.3%), pancreas 18814 (17.2%), bile duct 1922 (21.6%), gall bladder 1593 (15.8%) and esophagus cancer 11493 (10.7%)]. There were differences in types of PC interventions utilized in the entire group: surgery 6569 (16.1%), radiation 6964 (17.1%), systemic therapy 12951 (31.8%), pain management 5100 (12.5%) and combination therapy 9203 (22.6%). Factors associated with PC on univariate analysis included sex, race, insurance status, median income, education level, Charlson/Deyo comorbidity score, and year of diagnosis (all p<0.01). On multivariate analysis, female gender (1.09, 95% CI: 1.06-1.11), higher education level (Level 4: 1.36, 95%CI: 1.31-1.42), higher Charlson/Deyo Score (Score: 2: 1.28, 95%CI: 1.23-1.32), and a later year of diagnosis (2011-2013: 1.39, 95%CI: 1.35-1.43) were associated with greater receipt of PC. Furthermore, older patients (75+ years: 0.90, 95%CI: 0.85-0.96), HS race (0.78, 95%CI: 0.74-0.82), private insurance (0.80, 95%CI: 0.76-0.85) and higher income (0.78, 95%CI: 0.75-0.81) were associated with less receipt of PC. Overall survival for the entire cohort is poor at 4.45 months (p<0.001) for the PC group and 6.60 months (p<0.001) for the no PC group. Conclusion: Although PC use has increased over time, it remains underutilized in MFC. Disparities exist in receipt of PC in regard to age, race, gender, insurance status, education, comorbidities and year of diagnosis. Additional research is necessary to better optimize PC use in metastatic cancers of the foregut and mitigate potential disparities. Note: This abstract was not presented at the conference. Citation Format: Michelle Ju, Subhadeep Paul, Adam Yopp, Sam Wang, Matthew Porembka. Underutilization of palliative care in metastatic foregut cancer patients is associated with socioeconomic disparities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C006.