Race/ethnicity and sex: Assessment of trends and disparities in palliative care utilization among patients with de novo metastatic breast cancer.

Abstract

82 Background: Palliative care services (PCS) have been shown to improve the quality of life of patients (pts) with late-stage cancers; however, they remain underutilized. Further, national trends and racial/ethnic disparities in PCS use among metastatic breast cancer pts by sex are unclear. Methods: We analyzed data from pts with de novo metastatic breast cancer in the 2004-2019 National Cancer Database (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and American Cancer Society. Per NCDB, PCS, including surgery, radiotherapy, systemic therapy, and/or pain management, were performed to manage pain or symptoms/side effects; use was categorized as “yes/no.” Racial/ethnic groups included non-Hispanic (NH) Asian, NH Black, Hispanic, and NH White. Sex was reported as “female/male” per NCDB. Trends in PCS use were evaluated. Multivariable logistic regression models were fit to assess racial/ethnic disparities in PCS use by sex. Results: Of 134,943 pts (mean age 62 years [SD=14]), 98.6% were female. Most (74.1%) were NH White, followed by 17.2% NH Black, 5.9% Hispanic, and 2.7% NH Asian. Sociodemographic and clinicopathologic factors differed significantly across racial/ethnic groups. Overall, 20.3% used PCS, with a significant increase from 15.6% in 2004-2005 to 24.6% in 2018-2019 ( p trend <.001). The percentage of PCS use was 20.3% in female pts, with a significant increase from 15.7% in 2004-2005 to 24.6% in 2018-2019 ( p trend <.001). Similarly, 20.2% of male pts used PCS, with a significant increase from 12.7% in 2004-2005 to 24.1% in 2018-2019 ( p trend <.001). 21.0 % of NH White, 19.5% of NH Black, 17.1% of NH Asian, and 15.2% of Hispanic female pts used PCS; and 21.5% of NH White, 16.9% of NH Black, 15.4% of NH Asian, and 15.0% of Hispanic male pts did. In the adjusted regression models, NH Black (adjusted odds ratio [AOR]=0.88, 95% CI: 0.84-0.92, p<.001), NH Asian (AOR=0.74, 95% CI: 0.67-0.81, p<.001), and Hispanic (AOR=0.64, 95% CI: 0.59-0.69, p<.001) female pts were less likely to have used PCS than NH White female pts. NH Black male pts were less likely to have used PCS than their White male counterparts (AOR=0.57, 95% CI: 0.39-0.82, p=.002). Although Hispanic (AOR=0.67, 95% CI: 0.34-1.32, p=.246) and NH Asian (AOR=0.47, 95% CI: 0.16-1.36, p=.166) male pts were also less likely than NH White male pts to have used PCS, these differences were not statistically significant. Conclusions: The current study reports a low prevalence of PCS utilization, though with significant increases from 2004-2005 to 2018-2019, and highlights racial/ethnic disparities in utilization among pts with de novo metastatic breast cancer, regardless of sex. Equity-focused cancer supportive care programs should consider improving the utilization of, and equitable access to, PCS in this patient population, particularly in racial/ethnic minority communities.