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. 2021 Feb;160(2):469-476.
doi: 10.1016/j.ygyno.2020.11.031. Epub 2020 Dec 2.

Racial and ethnic disparities in palliative care utilization among gynecological cancer patients

Jessica Y Islam  1 , April Deveaux  2 , Rebecca A Previs  3 , Tomi Akinyemiju  4
Affiliations

Racial and ethnic disparities in palliative care utilization among gynecological cancer patients

Jessica Y Islam et al. Gynecol Oncol. 2021 Feb.

Abstract

Background: Palliative care (PC) is recommended for gynecological cancer patients to improve survival and quality-of-life. Our objective was to evaluate racial/ethnic disparities in PC utilization among patients with metastatic gynecologic cancer.

Methods: We used data from the 2016 National Cancer Database (NCDB) and included patients between ages 18-90 years with metastatic (stage III-IV) gynecologic cancers including, ovarian, cervical and uterine cancer who were deceased at last contact or follow-up (n = 124,729). PC was defined by NCDB as non-curative treatment, and could include surgery, radiation, chemotherapy, and pain management or any combination. We used multivariable logistic regression to evaluate racial disparities in PC use.

Results: The study population was primarily NH-White (74%), ovarian cancer patients (74%), insured by Medicare (47%) or privately insured (36%), and had a Charlson-Deyo score of zero (77%). Over one-third of patients were treated at a comprehensive community cancer program. Overall, 7% of metastatic gynecologic deceased cancer patients based on last follow-up utilized palliative care: more specifically, 5% of ovarian, 11% of cervical, and 12% of uterine metastatic cancer patients. Palliative care utilization increased over time starting at 4% in 2004 to as high as 13% in 2015, although palliative care use decreased to 7% in 2016. Among metastatic ovarian cancer patients, NH-Black (aOR:0.87, 95% CI:0.78-0.97) and Hispanic patients (aOR:0.77, 95% CI:0.66-0.91) were less likely to utilize PC when compared to NH-White patients. Similarly, Hispanic cervical cancer patients were less likely (aOR:0.75, 95% CI:0.63-0.88) to utilize PC when compared to NH-White patients.

Conclusions: PC is highly underutilized among metastatic gynecological cancer patients. Racial disparities exist in palliative care utilization among patients with metastatic gynecological cancer.

Keywords: Cervical cancer; Gynecologic cancers; National Cancer Data Base; Ovarian cancer; Palliative care; Racial disparities; Uterine cancer.

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Conflict of interest statement

Disclosures: Authors report no conflict of interest.

Figures

Figure 1:
Figure 1:
Racial and Ethnic Differences in Type of Palliative Care Utilized among Deceased Patients in the United States, National Cancer Data Base (2004 – 2016)
Figure 2:
Figure 2:
Racial and Ethnic Differences in Palliative Care Utilization by Month from Diagnosis to Last Contact or Death by Gynecological Cancer Site among Deceased Patients in the United States, National Cancer Data Base (2004–2016)
Figure 3:
Figure 3:
Associations of Race/Ethnicity to Palliative Care Utilization Among Deceased Patients with Metastatic Gynecological Cancers
See this image and copyright information in PMC

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