Palliative care utilization and racial and ethnic disparities among women with de novo metastatic breast cancer in the United States

Giap, Fantine; Jun, Sung; Oladeru, Oluwadamilola T.; Hong, Young‐Rock; Yu, Brian; Vega, Raymond B. Mailhot; Brooks, Eric D.; Singh, Anurag K.; Okunieff, Paul; Mendenhall, Nancy P.; Bradley, Julie A.

doi:10.1007/s10549-023-06963-7

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…Treatment receipt was reported for different types of SACT which included chemotherapy, immunotherapy, targeted therapy which included cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i), unspecified SACT and endocrine therapy. Seven studies reported chemotherapy where overall receipt ranged from 22 to 60% [ 29 , 30 , 35 , 37 , 38 , 41 , 43 ]. Receipt of endocrine therapy was reported in one study which evaluated factors associated with treatment receipt among women with hormone receptor-positive disease where overall treatment receipt was reported as 70.8% [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…The inverse was reported for aggressive EOL care with increased likelihood of treatment receipt for those with greater comorbidities ( OR 1.20 (1.03–1.39) > 2, OR 2.00 (1.70–2.35)) where those with no comorbidities were the reference group [ 29 ]. Similarly, for receipt of palliative care which included non-curative systemic therapy for women with de novo metastatic disease, those with greater comorbidities had an increased likelihood of receipt of palliative care than women with no comorbidities ( OR 1.27, 1.17–1.39) [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Hormone receptor status was reported across five moderate quality studies which reported data exclusively for patients with a secondary breast cancer diagnosis [ 8 , 29 , 30 , 34 , 35 ]. Two studies reported chemotherapy receipt and receipt of SACT respectively.…”

Section: Resultsmentioning

confidence: 99%

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Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review

Pearson,

Taylor,

Marsden

et al. 2024

Syst Rev

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Background The review aimed to investigate geographic and sociodemographic factors associated with receipt of systemic anticancer therapies (SACT) for women with secondary (metastatic) breast cancer (SBC). Methods Included studies reported geographic and sociodemographic factors associated with receipt of treatment with SACT for women > 18 years with an SBC diagnosis. Information sources searched were Ovid CINAHL, Ovid MEDLINE, Ovid Embase and Ovid PsychINFO. Assessment of methodological quality was undertaken using the Joanna Briggs Institute method. Findings were synthesised using a narrative synthesis approach. Results Nineteen studies published between 2009 and 2023 were included in the review. Overall methodological quality was assessed as low to moderate. Outcomes were reported for treatment receipt and time to treatment. Overall treatment receipt ranged from 4% for immunotherapy treatment in one study to 83% for systemic anticancer therapies (unspecified). Time to treatment ranged from median 54 days to 95 days with 81% of patients who received treatment < 60 days. Younger women, women of White origin, and those women with a higher socioeconomic status had an increased likelihood of timely treatment receipt. Treatment receipt varied by geographical region, and place of care was associated with variation in timely receipt of treatment with women treated at teaching, research and private institutions being more likely to receive treatment in a timely manner. Conclusions Treatment receipt varied depending upon type of SACT. A number of factors were associated with treatment receipt. Barriers included older age, non-White race, lower socioeconomic status, significant comorbidities, hospital setting and geographical location. Findings should however be interpreted with caution given the limitations in overall methodological quality of included studies and significant heterogeneity in measures of exposure and outcome. Generalisability was limited due to included study populations. Findings have practical implications for the development and piloting of targeted interventions to address specific barriers in a socioculturally sensitive manner. Addressing geographical variation and place of care may require intervention at a commissioning policy level. Further qualitative research is required to understand the experience and of women and clinicians. Systematic review registration PROSPERO CRD42020196490

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review

Pearson,

Taylor,

Marsden

et al. 2024

Syst Rev

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A pragmatic qualitative study to explore women's and clinicians' experience of access to systemic anti-cancer therapies for the treatment of secondary breast cancer

Pearson,

Taylor,

Krishan

et al. 2024

European Journal of Oncology Nursing

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The Impact of Palliative Care Consultation on Aggressive Medical Interventions in End-of-life Among Patients with Metastatic Breast Cancer: Insights from the U.S. National Patient Sample

Zhang,

Lovell,

Subramaniam

et al. 2024

J Palliat Care

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Background Advancement in treatment has led to prolonged survival and a rising number of women living with metastatic breast cancer (MBC) in the United States. Due to its high symptom burden, it is recommended that palliative care be integrated into the standard care to help improve quality of life. However, little is known about the use of palliative care among MBC patients in the nation. Objectives To determine utilization of palliative care consult (PCC) after metastasis and the influence of PCC on healthcare utilization in the end of life among women living with MBC in the US. Methods This retrospective cohort study examined a national electronic health record database to quantify the PCC use after metastasis diagnosis until death and the associations of PCC with Emergency Department (ED), Intensive Care Unit (ICU), and chemotherapies in the end-of-life women (age ≥ 18 years) living with MBC. Results From a cohort of 2615 deceased MBC patients, 37% received PCC in the last 6 months of life. Patients who had received PCC in the end-of-life were more likely to be hospitalized, admitted to ED and ICU, and receive chemotherapies in the last 60 days before death. However, patients who had received end-of-life PCC had less hospital and ED visits and received less chemotherapies after PCC initiated. Conclusion While PCC can reduce end-of-life aggressive interventions, it was underutilized among patients with MBC in the end-of-life. A myriad of clinical and patient factors may still challenge timely consultation. We urge for future endeavors in developing strategies to remove barriers in the implementation, especially earlier in the disease course, to assure timely PC treatments and reduce discomfort amid aggressive interventions for MBC.

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Palliative care utilization and racial and ethnic disparities among women with de novo metastatic breast cancer in the United States

Cited by 6 publications

References 16 publications

Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review

Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review

A pragmatic qualitative study to explore women's and clinicians' experience of access to systemic anti-cancer therapies for the treatment of secondary breast cancer

The Impact of Palliative Care Consultation on Aggressive Medical Interventions in End-of-life Among Patients with Metastatic Breast Cancer: Insights from the U.S. National Patient Sample

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