Palliative care usage in large cell lung carcinoma: An analysis of the National Cancer Database.

Abstract

266 Background: The treatment approach for large cell lung carcinoma (LCLC) typically involves a multimodal treatment strategy, including chemotherapy, radiation therapies, and immunotherapy, to target both the primary tumor and any metastatic lesions. Palliative care (PC) optimizes the treatment of individuals with LCLC by relieving suffering improving quality of life for patients and their loved ones. When implemented early, PC can lengthen survival in patients with advanced non-small cell lung cancer (NSCLC) like LCLC. The association between PC utilization and race, ethnicity, insurance status, education level, income level, rural/urban geography, and facility type in the face of a LCLC diagnosis has not yet been investigated in isolation from other types of NSCLC. We will analyze these factors in this study to highlight key discrepancies in the implementation of PC when treating LCLC. Methods: A retrospective study was conducted using data collected from adults diagnosed with all subtypes of LCLC between 2004 and 2020 in the National Cancer Database to evaluate trends in PC utilization. Demographic characteristics were studied with regards to the use of PC. Multivariate with binary logistic regression was implemented to analyze the following variables: age, sex, Hispanic status, race, Charlson-Deyo comorbidity score (CDCS), education level quartile, income status quartile, facility region, geographic residence status, and primary insurance status. Exclusion criteria included missing values. Results: Among the 25362 patients diagnosed with LCLC, about 12.8% received PC (n = 3727). Patients who were more likely to receive PC had a CDCS of ≥3 (p = 0.017, CI = 1.04-1.47). Additionally, PC usage was more likely in rural (p = 0.003, CI = 1.05-1.27) and urban (p = 0.013, CI = 1.06-1.62) settings compared to metro settings. Patients who were less likely to utilize PC were Black (p = 0.018, CI = 0.77-0.98) and male (p < 0.001, CI = 0.82-0.95). Facility locations in the South (Atlantic) and West (Mountain and Pacific) regions were less likely to provide PC services. Patients paying primarily with Medicaid were the most likely to undergo PC compared to their counterparts lacking insurance or having different insurance (private, Medicare, other government). There was no statistically significant difference in PC usage among different education levels and income brackets. Conclusions: We identified patterns in PC utilization among individuals with LCLC. Variables correlated with PC usage include CDCS, race, facility location, and primary payor at diagnosis. Given that LCLC is aggressive, PC can complement curative treatments to provide comprehensive cancer care. We hope this study will serve as a foundation for reducing health disparities in the treatment of LCLC, thus advancing health equity.