Abstract
Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.
Highlights
Palliative care is an integral aspect of high-quality cancer treatment
We explored health care access measures to inform the under-utilization of palliative care services among patients with metastatic gynecological cancers in the United States
We observed that patients who had Medicaid or who were uninsured were more likely to use palliative care, that individuals living far away from their provider were less likely to receive palliative care, and that individuals receiving care at academic, or research hospitals were less likely to receive palliative care compared to the referent group
Summary
Palliative care is an integral aspect of high-quality cancer treatment. The UnitedStates (U.S.) National Comprehensive Cancer Network (NCCN) recommends palliative care should begin at cancer diagnosis and be delivered concurrently with regular cancer life-prolonging treatment to relieve symptom burden [1]. Palliative care is an integral aspect of high-quality cancer treatment. States (U.S.) National Comprehensive Cancer Network (NCCN) recommends palliative care should begin at cancer diagnosis and be delivered concurrently with regular cancer life-prolonging treatment to relieve symptom burden [1]. Palliative care can improve health-related quality of life by addressing symptoms frequently experienced during cancer treatment, such as pain, nausea, fatigue, neuropathy, as well as psychosocial symptoms [2].
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