Underutilization of palliative care in metastatic pancreatic cancer patients is associated with socioeconomic disparities

Abstract

Presenter: Michelle Ju MD | University of Texas Southwestern Medical Center Background: Approximately half of pancreatic cancer patients present with metastatic disease at initial diagnosis. Metastatic disease is frequently associated with debilitating symptoms that have significant negative impact on patients’ quality of life. Palliative care is effective in mitigating disease-, psychosocial-, and treatment-related effects. However, palliative care remains heavily underutilized in patients with metastatic pancreatic cancer. Our aim was to determine factors associated with receipt of palliative care. Our main outcome of interest was the rate of palliative care utilization in patients with metastatic pancreatic cancer. Secondary outcomes were determining the impact of various clinicopathologic and socioeconomic factors associated with likelihood of receiving palliative care. Methods: We conducted a retrospective review of National Cancer Database patients 18 years of age or older diagnosed with metastatic pancreatic cancer between 2004-2013. Chi-squared tests were used to analyze the differences between the two cohorts: those who received palliative care and those who did not. Logistic regression was performed to assess the impact of various clinicopathologic factors on the likelihood of receiving PC. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Results: Palliative care utilization rates increased over time (23.9% between 2004-2006 vs. 39.6% between 2007-2010 vs. 36.5% between 2011-2013). Medicaid insurance status, median income < $46,000/year, higher Charlson/Deyo Score, and later year of diagnosis were associated with increased likelihood of palliative care interventions. Patients 75 years of age or older, with private insurance, or living in areas with the lowest average education level (≥29% of residents without a high school degree) were less likely to receive palliative care. When receipt of palliative care was stratified by race, Hispanics (OR 0.69, 95% CI 0.64-0.75), African Americans (OR 0.88, 95% CI 0.83-0.92), and Asians (OR 0.86, 95% CI 0.77-0.97) were all significantly less likely to have undergone palliative care interventions compared to non-Hispanic whites. Patients with private insurance were less likely to receive palliative care than uninsured patients (OR 0.88, 95% CI 0.81-0.96). Conclusion: Differences in palliative care receipt rates exist with regards to racial/ethnic and socioeconomic factors such as insurance status, median household income, and education level. Further studies are needed to delineate why these racial/ethnic and socioeconomic disparities exist with regards to palliative care utilization in metastatic pancreatic cancer patients.