Palliative care utilization and trends among patients with metastatic breast cancer: A SEER-Medicare analysis.

Abstract

75 Background: Receiving palliative care (PC) is associated with improving quality of life in patients with cancer. Despite its clinical benefits, limited data is available regarding PC utilization among the metastatic breast cancer population. Examining the trends and current patterns of PC provide an opportunity for improved effective implementation of PC in management of patients with breast cancer. Methods: SEER-Medicare linked data was queried to identify patients with metastatic breast cancer aged > 65 years between 2006 and 2017. PC utilization since diagnosis was identified using ICD-9 code V66.7 or ICD-10 Z51.5. Descriptive statistics were used to summarize patient characteristics by the receipt of PC. Multivariable logistic regression was estimated to identify predictors of PC use. Trends in PC utilization were then compared by patient race/ethnicity, residential region, and census poverty rate. Results: Of 11,245 patients with metastatic breast cancer diagnosed between 2006 and 2017 (median survival, 17.9 months), 1,756 (15.6%) received PC (median time from diagnosis to PC, 18.5 months). During the study period, PC use increased significantly from 2.5% in 2006-2007 to 28.1% in 2016-2017 (P trend <.001). Patients with metastatic breast cancer who received PC were more likely to be younger (20.6% among 65-69 years old vs. 11.9% among 80+), living in the West census region (17.2% vs. 14.1% in South), urban areas (16.8% vs. 8.2% in rural), and low poverty rate (16.1% with < 5% poverty level vs. 12.9% with > 20%) (P all <.05). There was no significant difference observed by race or ethnicity (P >.05). Conclusions: There was a significant increase in PC utilization among patients with metastatic breast cancer aged > 65 years between 2006 and 2017. However, its utilization rate remains suboptimal, with geographic, age and income disparities in PC use.