Trends and guideline-related changes in provision of palliative care in older women with gynecologic malignancies

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Objectives: To determine if the rate of palliative care consultation (PCC) in older women with gynecologic malignancies increased after the publication of the American Society of Clinical Oncology guidelines in 2012. Additionally, to identify factors associated with utilization of palliative care. Methods: We included women ≥ 66 years with stage III-IV, ovarian, uterine, cervix or vulvar cancer diagnosed in 2011 and 2013 in the linked Surveillance Epidemiology, End Results (SEER)- Medicare database. Patient demographic, cancer, and treatment characteristics were extracted. We evaluated PCC within 365 days of diagnosis (PCC365) and within 56 days of diagnosis (PCC56). We used a multivariable Cox proportional hazard model to compare PCC in 2011 versus 2013. We identified factors associated with PCC in women diagnosed with cancer in 2013 using a univariate and multivariable logistic regression. Results: We identified 2,643 women diagnosed with advanced gynecologic malignancies. 56% of patients had ovarian cancer, 34% uterine cancer, 8% cervical cancer and 3% vulvar cancer. In 2011, 12% of women had a PCC365 versus 14% in 2013. Taking into account multiple factors, women diagnosed in 2013 were more likely to have a PCC365 than women diagnosed in 2011 (adjusted HR 1.36, 95% CI 1.09, 1.71). Women diagnosed with an advanced gynecologic malignancy in 2013 who were Black versus White (adjusted HR 1.72, 95% CI 1.06, 2.78), had a Charlson comorbidity index of 3 versus 0 (adjusted HR 1.81, 95% CI 1.17, 2.80) or stage IV verus stage III cancer (adjusted HR 1.79, 95% CI 1.26, 2.54) were more likely to receive PCC365. Women who received initial cancer treatment with surgery were less likely to receive PCC365 (adjusted HR 0.52, 95% CI 0.35, 0.78). Conclusions: The rate of palliative care in women with advanced gynecologic malignancies increased slightly, although significantly, between 2011 and 2013 but the absolute rate remains low despite changes in recommendations. New innovations are needed to increase concurrent palliative care with standard oncology treatment for woman with advanced gynecologic malignancies.