Palliative medicine referral trends by demographics for patients with stage IV cancer at an urban safety net hospital.

Abstract

e18541 Background: Multiple randomized trials have shown that early referral to palliative clinic improves quality of life and has survival advantages when combined concurrently with standard oncology care in patients with advanced cancer. We reviewed data referral trend data for stage 4 cancer patients at an urban safety net hospital with the goal of characterizing demographic factors that may be associated with the amount of time both to referral and to the patient establishing care with palliative medicine in order to identify possible barriers to care. Methods: We identified patients with stage IV cancer seen in our oncology clinic from 2017-2020 using tumor registry cancer staging. We conducted a retrospective chart review of these patients. Demographic data were collected through chart review using a standardized data collection tool. We calculated data using relative frequency. Results: A total of 249 patients with Stage IV cancer were identified during this timeframe. Of these, 137 patients (55%) were referred to palliative clinic. This included 77 male and 60 female patients. The average time between the patient’s first oncology visit and a referral made to the palliative clinic was 187 days, with much higher referral time for female patients (279 days). The referral relative frequency was high among African American and Asian population of 1.46 and 1.20, respectively; with highest rate of 2.14 for African American women. Patients identifying as African and Hispanic had the lowest relative referral frequency, with 0.29 and 0.77, respectively. The average number of days between referral made and first palliative appointment was 41 days, with longer delay in female patients (54 days). The time to first appointment relative frequency was high among Asian population (4.04) and low among African (0.36) and Hispanics (0.63). Patients with Medicaid and those who were uninsured were referred to palliative clinic sooner with average of 121 days and 109 days respectively, as opposed to patients with private insurance (387 days). The appointment relative frequency was also earlier for uninsured and Medicare patients of 0.60 and 0.92, respectively. Conclusions: Our study shows that there is delay in getting palliative care referrals and appointments among African American and Asian population, and female patients. This can be due to cultural and systemic barriers: palliative care is a newer field, with a broader community understanding of its purpose and benefits still growing in many patient populations. We can improve the gap with patient-oriented targeting the identified subgroups who demonstrated more opportunity. The study also highlights more expeditious care for patients with Medicare and uninsured patients, as opposed to private insurance. These early referrals may be due to higher psychosocial needs and clinical requests for help from the palliative interdisciplinary team.