Supportive/palliative care use among patients with lung cancer: Rates and barriers.

Abstract

e19608 Background: Lung cancer is the leading cause of cancer mortality and is associated with significant symptomatic co-morbidity along with diminished quality of life. Despite the expanding development of supportive and palliative care services, little is known about the rate of utilization and barriers that prevent use of these services among lung cancer patients. Methods: We performed a cross-sectional analysis of an ongoing cohort study of patients with lung cancer seen in an urban, medical oncology clinic. Patients age 18 or older who had a primary diagnosis of lung cancer and a Karnofsky performance status of 60 or greater were included. Patients self-reported their use of cancer supportive care services along with any perceived barriers. Multivariate logistic regressions were used to evaluate the factors related to the use of supportive care services. Results: 103 patients participated in this survey with a median age of 61, range (27-83). 59.2% were female, 84.5% White/11.7% African American/3.8% others, and 37.9% had an education level of high school or less. Among the participants, 56% had not used supportive services since their cancer diagnosis. The most common services used were nutrition (24.3%), psychiatric/psychological evaluation/counseling (17.5%), and physical therapy (12.6%). Pain/Palliative care and cancer rehabilitation consultations were only used by 5.8% and 2% of the participants respectively. In a multivariate analysis, higher education level was associated with greater use of supportive care, adjusted odds ratio (AOR) 2.55, 95% confidence interval (CI) 1.06-6.22, p=0.04, while being married was associated with less use of supportive care, AOR 0.37, 95% CI 0.16-0.87, p=0.023. The barriers to using these services were lack of awareness (23%), lack of physician referral (23%), lack of time (8.7%), transportation (6.8%) and expense (5.8%). Conclusions: More than half of the lung cancer patients have not accessed supportive care since cancer diagnosis and often cite lack of awareness and lack of physician referral as barriers. Further research is needed to understand how to best facilitate the integration of these services into conventional cancer treatment to improve the overall care of lung cancer patients.