Disparities associated with the receipt of palliative care in patients with metastatic gastric cancer.

Abstract

28 Background: Metastatic gastric adenocarcinoma (mGA) is frequently associated with debilitating symptoms that negatively impact quality of life. We aim to determine the rate of palliative care (PC) use in mGA and the factors which are associated with receipt of PC. Methods: Using the National Cancer Database, mGA patients were selected. Receipt of PC as defined by the NCDB participant use file was correlated to demographic and clinicopathologic factors. As defined according to NCDB, 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, 45519 patients with mGA and reported PC status were identified. Median age was 66 years (IQR: 55-76 years) and 64% were male. 7365 (16.2%) patients received PC. PC utilization increased over time (2004-6 13.4%, 2007-10 15.8%, 2011-13 19.1%; p < 0.001). Factors associated with PC on univariate analysis included insurance status, education level, income, sex, race, Charlson/Deyo comorbidity score, and year of diagnosis (all p < 0.001). On multivariate analysis, female sex (0.87, 95%CI: 0.83-0.92) and minority race were associated with less receipt of PC (Hispanic 0.73, 95%CI: 0.66-0.80, Black 0.87, 95%CI: 0.80-0.95, Asian 0.89, 95%CI: 0.77-0.98 compared to non-Hispanic White patients). Higher education level was associated with greater receipt of PC (1.46, 95%CI: 1.31-1.62). Receipt of PC was associated with decreased overall survival (PC 4.8 months vs no PC 6.0 months; p < 0.001). Conclusions: Although use of PC has increased over time, PC is underutilized in mGA. Disparities exist in receipt of PC in regard to race, gender, and education. Additional research is necessary to better optimize PC use in mGA and mitigate potential disparities.