Access to palliative care in patients with multiple myeloma in the USA: A National Cancer Database (NCDB) analysis of years 2004-2020.

Abstract

7563 Background: Palliative care (PC) can improve the quality of life for patients with multiple myeloma (MM). Despite its recognized importance, research gaps persist in understanding factors influencing PC accessibility and utilization, particularly in the diverse MM patient landscape in the real-world setting. This study explores potential associations between race, ethnicity, socioeconomic factors, and PC access for MM patients in the USA. Methods: Utilizing the NCDB, we identified 202,949 MM patients diagnosed from 2004 to 2020. Multivariate logistic regression analysis was conducted with SAS version 9.4, to determine independent factors predicting PC access. Results: Analysis of 202,949 MM patients revealed notable disparities for access to PC. Female patients exhibited lower PC odds (OR: 0.94, p < 0.0001) compared to male patients, as did Black patients (OR: 0.80, p < 0.0001) and other racial groups (OR: 0.84, p < 0.0001) compared to White patients. Hispanic ethnicity was associated with lower PC utilization odds (OR: 0.84, p < 0.0001) compared to non-Hispanics. Earlier years (2004-2007) showed higher PC odds (OR: 1.12, p < 0.0001), while subsequent years (2008-2011, 2012-2015) exhibited lower odds (OR: 0.93, p = 0.0009; OR: 0.87, p < 0.0001, respectively) compared to the most recent years (2016-2020). Academic settings had lower PC odds than non-academic facilities (OR: 0.78, p < 0.0001). Insurance status varied, with no insurance (OR: 1.40, p < 0.0001), Medicaid (OR: 1.17, p < 0.0001), and other government insurance (OR: 1.38, p < 0.0001) linked to higher PC odds compared to private insurance. Lower annual household incomes (<$38,000, $38,000-$47,999, $48,000-$62,999) had increased PC odds compared to higher incomes (>$63,000) (all p < 0.0001). Areas with a higher percentage of individuals without a high school degree exhibited lower PC odds, notably 21% (OR: 0.83, p < 0.0001) and 13.0%-20.9% (OR: 0.94, p = 0.0222) compared to <7.0% without a high school degree. Greater distance (>30 miles) reduced PC odds compared to shorter distance (<10 miles) to treatment facility (OR: 0.83, p < 0.0001). A Charlson-Deyo score of 1 increased PC odds compared to a score of 0 (OR: 1.12, p < 0.0001). Conclusions: Our real-world analysis reveals substantial disparities in MM patients’ PC access and utilization. Female patients and minority groups (Blacks and Hispanics) face significant challenges. The dynamic trends over time and socioeconomic impacts underscore the need for integrating PC and targeted interventions for overall MM patient well-being. Our findings pave grounds for future prospective studies.