Trends in palliative care interventions for stage IV esophageal cancer: An analysis of the NCDB.

Abstract

e24104 Background: Palliative care (PC) addresses patient quality of life and satisfaction with care. Oncological PC can be manifested through surgery, radiation, chemotherapy, and pain management. These treatments do not cure disease but improve quality of life. The survival rate for stage IV esophageal cancer is 15-20%, making it an excellent candidate for PC. This study will analyze patterns in who received each type of PC. Methods: This study looked at 8808 patients with stage IV esophageal cancer who received PC interventions from 2004-2018 in the National Cancer Database (NCDB). The NCDB listed 4 types of PC: surgical, radiation, chemotherapy/hormone therapy, and pain management. All modalities were to “alleviate symptoms, but no attempt to diagnose, stage, or treat the primary tumor is made.” Exclusion criteria was concurrent tumors and missing data. Histology subgroups were divided into adenocarcinoma, squamous cell carcinoma, and other, based on ICD-O-3 coding. Cross tabulation analysis was performed using Pearson chi-square and ANOVA tests. Kaplan Meyer curves with log-rank analysis were used to determine survival probabilities. Results: Of PC interventions, 9.0% were surgical, 42.5% radiation, 41.1% chemotherapy, and 7.4% pain management with no other treatment. From 2004-2018 pain management increased 380% and chemotherapy increased 250%. Radiation increased 32%, and surgical decreased 39%. Surgical patients were more often male (79.9%), white (87.4%), non-Hispanic (97.3%), treated at an academic/research program (39.6%), and have a mean survival of 8.6 months. The most common surgical interventions were photodynamic therapy and esophagectomy with partial gastrectomy. Radiation patients more often male (82.3%), white (83.9%), non-Hispanic (96.5%), treated at a comprehensive community cancer center (39.7%), and have a mean survival of 9.1 months. Most common phase I radiation treatments were external beams (photons) and external beams NOS. Chemotherapy patients were more likely to be male (84.5%), white (88.2%), non-Hispanic (96.8%), treated at a comprehensive community cancer program (39.4%), and have a mean survival of 13.9 months. Chemotherapy patients most often received multiagent chemotherapy and single agent chemotherapy. Pain management patients were more often male (80.2%), white (88.0%), non-Hispanic (96.5%), treated at an academic/research program (38.8%), and have a mean survival of 4.1 months. Chemotherapy patients had average age of 62, while all other interventions had an average age of 65 (p < 0.001). Conclusions: Major differences between subtypes of PC interventions included location of treatment, average age at diagnosis, and mean survival. Chemotherapy patients were diagnosed younger and had a longer mean survival time. Pain management patients had the lowest mean survival time. This data can be utilized as PC utilization increases in the United States.