Utilization of Palliative Care in Diffuse Large B Cell Lymphoma Patients Is Linked to Insurance Type and Household Income

Abstract

Background There is increasing evidence supporting the use of palliative care in the management of both solid and hematologic malignancies. As an integral part of oncologic care, palliative care has been reported to improve survival in diverse malignancies. Our study aimed to describe trends in the utilization of palliative care in diffuse large B cell lymphoma (DLBCL) patients. Methods Patient-level data of patients with DLBCL reported between 2004 to 2019 was extracted from the National Cancer Data Base (NCDB). After excluding 1173 patients with unknown palliative care status, we included 264,549 patients in our analyses. Chi-square tests were used to assess the characteristics of palliative care recipients and non-recipients. Multivariate logistic regression was used to identify the variables which influenced the likelihood of receiving palliative care. Age (<45, 45-59,60-74, 75+), sex (male and female), race (Hispanics, Whites, Blacks, Asian), Charlson-Deyo comorbidity score, insurance status (uninsured, private insurance, Medicare, Medicaid, other government), median household income (<$40227, $40227-$50353, $50,354-$63332, >$63333), educational status (as specified by the database), facility type (community, academic, comprehensive and integrated cancer centers), and year of diagnosis (2004-2007, 2008-2011, 2012-2015, 2016-2019) were variables included in our study. Statistical analyses were performed using SPSS. Results Of 264,549 DLBCL patients, 3.2% (n=8460) utilized palliative care. The utilization of palliative care increased significantly from 2004-2007 to 2016-2019 (2.6% vs 3.71%, p < 0.001). A greater proportion of patients older than 75 years old received palliative care than those younger than 45 years old (5.09% vs 1.66% p<0.001). Patients of Hispanic origin were less likely to receive palliative care compared to Whites (OR 0.74, 95% CI 0.65-0.83). No statistically significant difference in palliative care utilization was found between Whites and other non-Hispanic groups. Privately insured patients had the lowest palliative care utilization amongst all insurance groups and these patients were less likely to receive palliative care compared to uninsured patients (OR 0.70, 95% CI 0.59-0.83). The odds of receiving palliative care were higher at integrated cancer centers than at community care programs (OR 1.17, 95% CI 1.05-1.32). DLBCL patients from households with a median income of >$63,333 were less likely to receive palliative care than those from low-income (<$40,227) households (OR 0.77, 95% CI 0.70-0.85). Conclusions We made several observations in this most up-to-date and largest study on the utilization of palliative care in DLBCL patients. While there is a rise in the use of palliative care in DLBCL in recent years, the overall use of palliative care in these patients remains low. There was a higher utilization of palliative care in patients treated in integrated cancer centers. However, we found an unexpectedly low utilization of palliative care among privately insured patients and in those with higher incomes. A plausible explanation for this finding might be that palliative care measures are not covered by private insurance. It is also possible that affluential patients, and/or those with private insurance, are more likely to pursue novel treatments. Alternatively, these patients might be more likely to be offered further chemotherapy by their oncologists rather than palliative care. These postulates should be further studied and could serve as a guide for health care policy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal