Racial and ethnic inequities of palliative care use among advanced Non‐Small cell lung cancer patients in the US

Abstract

Background With early intervention, palliative care (PC) can improve quality of life and increase survival among advanced‐stage non‐small cell lung cancer (aNCSLC) patients. However, PC is often offered late in the cancer treatment course and is underused. We characterized racial/ethnic inequities and the role of healthcare access in PC use among patients with aNSCLC. Methods We used data from the 2004–2016 National Cancer Database, including adults aged 18–90 years with aNSCLC (stage 3 or 4 at diagnosis; n = 803,618). Based on the NCCN guidelines, PC includes non‐curative surgery, radiation, chemotherapy, pain management, or any combination of non‐curative care. We examined PC use by sociodemographic and health care‐level characteristics. To evaluate the independent associations of race/ethnicity and health care access characteristics with PC, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Covariate adjustment sets varied by exposure determined using directed acyclic graphs. Results Our population was 55% male and 77% non‐Hispanic/Latinx (NH)‐White, with a mean age of 68 years. Overall, 19% of patients with aNSCLC used PC. Compared to NH‐White patients, NH‐Black (aOR:0.91,95% CI:0.89–0.93) and Hispanic/Latinx (aOR:0.80,95% CI:0.77–0.83) patients were less likely to use PC, whereas Indigenous (AI/AN) (aOR:1.18,95% CI:1.06–1.31) and Native Hawaiian/Pacific Islander (aOR:2.08,95% CI:1.83–2.36) patients were more likely. Overall, compared to the privately‐insured, uninsured (aOR:1.19,95% CI:1.11–1.28) and Medicaid‐insured patients (aOR:1.19,95% CI:1.14–1.25) were more likely to use PC. Conclusion PC is underutilized among NH‐Black and Hispanic/Latinx patients with aNSCLC. Insurance type may play a role in PC use among patients with aNSCLC.

Association of patient socioeconomic status with outcomes after palliative treatment for disseminated cancer

“…Our findings are largely in line with previous literature that has demonstrated lower rates of palliative treatment among racial and ethnic minorities 53 as well as patients treated at academic medical centers. 54 Additionally, among prostate cancer patients minoritized communities were less likely to discuss or use hospice based palliative care compared with other populations.…”

“…Additionally, patient-level attitudes and perceptions regarding the role of palliative treatment, hospice care and treatment near the end-of-life can also impact patient's decisions to seek palliative care and should be addressed. 53,54 We noted regional differences as well. Palliative treatment was higher in the Northeast and Midwest regions of the United States compared to the West and South.…”

“…Additionally, patient‐level attitudes and perceptions regarding the role of palliative treatment, hospice care and treatment near the end‐of‐life can also impact patient's decisions to seek palliative care and should be addressed. 53 , 54 …”

“…Provider training and ability to initiate timely discussions regarding end‐of‐life care and decisions toward fostering positive quality‐of‐life through hospice or complementary supportive care is critical. Additionally, patient‐level attitudes and perceptions regarding the role of palliative treatment, hospice care and treatment near the end‐of‐life can also impact patient's decisions to seek palliative care and should be addressed 53,54 …”

Impact of Palliative Care Utilization among Kidney Cancer Patients in US Hospitals: A National-Scale Analysis

“…However, current evidence of actual significant inequalities is not sufficient. Some studies have failed to establish the relationship between the utilization of palliative care and the inequalities factors, but some have been successful in doing this (12)(13)(14). The methodologies of the research and data collection impact the results of the studies, and some inequality factors affect one another, which further obscure the effects (15).…”