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. 2021 Jun;25(6):1404-1411.
doi: 10.1007/s11605-020-04742-z. Epub 2020 Jul 15.

Underutilization of Palliative Care in Metastatic Foregut Cancer Patients Is Associated with Socioeconomic Disparities

Michelle R Ju  1 , Subhadeep Paul  2 , Patricio Polanco  1 , Mathew Augustine  1 , John Mansour  1 , Sam Wang  1 , Matthew R Porembka  3
Affiliations

Underutilization of Palliative Care in Metastatic Foregut Cancer Patients Is Associated with Socioeconomic Disparities

Michelle R Ju et al. J Gastrointest Surg. 2021 Jun.

Abstract

Background: Metastatic foregut cancers (MFC) are associated with debilitating symptoms that negatively impact patients' quality of life. Palliative care (PC) is effective in mitigating disease-, psychosocial-, and treatment-related effects and may improve survival in select cases. Our study characterizes PC utilization rates in MFC and identifies factors associated with PC receipt.

Methods: We conducted a retrospective review of 228,027 National Cancer Database patients diagnosed with MFC between 2004 and 2016. Chi-squared tests were used to analyze differences between groups receiving and not receiving PC. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC.

Results: Overall PC utilization was low (17.8%). A greater proportion of patients not receiving PC were in the lowest median income quartile of < $38,000/year versus those receiving PC (18.1% vs 17.8%, p < 0.0001). Higher education was associated with increased likelihood of receiving PC (OR 1.23 for communities with < 6.3% no high school degree vs ≥ 17.6%, p < 0.0001). Hispanics were significantly less likely to receive PC compared to Whites (OR 0.72, 95% CI 0.68-0.76). Patients treated at academic centers were also more likely to receive PC compared to those treated in the community (OR 1.10, 95% CI 1.05-1.14).

Conclusions: PC is a key component in improving quality of life among MFC patients. Despite slight increases in PC rates over time, PC remains drastically underutilized. Significant racial and socioeconomic disparities in patterns of PC delivery exist. Further studies are needed to understand these disparities in order to identify key targets for interventions aimed at improving equity.

Keywords: Foregut cancers; Palliative care; Racial disparities.

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References

    1. Brown LM, Devesa SS. Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin N Am. 2002;11(2):235-56. doi: https://doi.org/10.1016/s1055-3207(02)00002-9 . - DOI - PubMed
    1. Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol. 2016;22(44):9694-705. doi: https://doi.org/10.3748/wjg.v22.i44.9694 . - DOI - PubMed - PMC
    1. Rubenstein JH, Shaheen NJ. Epidemiology, diagnosis, and management of esophageal adenocarcinoma. Gastroenterology. 2015;149(2):302-17 e1. doi: https://doi.org/10.1053/j.gastro.2015.04.053 . - DOI - PubMed - PMC
    1. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349(23):2241-52. doi: https://doi.org/10.1056/NEJMra035010 . - DOI - PubMed
    1. Institute NC. SEER Cancer Statistics Review, 1975–2006. Bethesda, MD. 2009. https://seer.cancer.gov/archive/csr/1975_2006/ .

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