Barriers to traditional palliative care for stage IV breast cancer patients, 2003-2012.

Abstract

120 Background: Multiple factors may impact ability of patients with Stage IV breast cancer to access traditional palliative care (PC), which centers on disease-altering procedures such as surgery, radiation therapy, and chemotherapy. To further investigate barriers to accessing PC, the National Cancer Data Base data from 2003-2012 was analyzed. Methods: Data was analyzed from 55,490 patients diagnosed with Stage IV breast cancer registered in the National Cancer Data Base. The outcome variable was patient use of PC. The predictor variables included sex, age, race, Charlson Comorbidity index, insurance status, income, education, year diagnosed, distance travelled, facility type, diagnosing/treating facility, and diagnosis to treatment interval. Univariate analysis was used to determine the prevalence of palliative care according to predictor variables. Multivariate Logistic regression was used to investigate the effect of each predictor variable on patient use of PC while adjusting for all other predictive factors. Results: Of the 55,490 Stage IV breast cancer patients analyzed, 17.38% received palliative care. Radiation therapy (8.76%) and chemotherapy, hormone, and other systemic treatments (4.51%) contributed to the bulk of PC. In multivariate analysis, after adjustment for all other predictor variables, race, income, education, distance travelled, and diagnosis to treatment interval were each shown to significantly predict use of PC. Black and Asian patients were 11.4% and 26.1% less likely to use PC than their white peers. Lower zipcode income, higher zipcode education, and shorter distance travelled were predictors of increased PC use. Shorter diagnosis to treatment interval was a predictor of increased PC use; compared to patients with a 31+ day interval, those with a 0-7 day interval were 67.71% more likely to receive PC and 8-31 day interval, 37%. Conclusions: Using univariate and multivariate analysis, we identified factors that may act as barriers to access traditional palliative care for patients diagnosed with Stage IV breast cancer. We observed that race, income, education, distance travelled, and diagnosis to treatment interval significantly predicted the use of palliative care.