Time and location of specialty palliative care for women dying with metastatic breast cancer

Abstract

Background: Despite guideline recommendations, evidence suggests many women with metastatic breast cancer (mBC) do not receive specialty palliative care services despite high morbidity burden. Given the varied prognoses and disease trajectories of women with mBC, relatively little is known about palliative care delivery in this growing population, including timing and frequency of visits, location (inpatient vs. outpatient), and reasons for referral.

Methods: Using electronic health record and tumor registry data from a North Texas Comprehensive Cancer Center (2010-2023), we identified women who died with de novo or recurrent mBC. We examined receipt of palliative care (inpatient and outpatient), reasons for referral, and timing of palliative care encounters by duration of patient survival. We used multivariable logistic regression to assess associations between receipt of specialty palliative care and demographic, clinical, and survival characteristics.

Results: Among 265 women with mBC, 55.5% received no palliative care. Only women with short survival (< 18 months) received palliative care within 8 weeks of diagnosis. Most palliative care encounters were inpatient and occurred within ~ 1 month of death. In adjusted models, comorbidities and younger age were strongly associated with receiving outpatient palliative care. Most women were referred to palliative care for multiple reasons, with long-term survivors more likely to be referred for goals of care discussions alone.

Conclusion: Palliative care for women with mBC is infrequent and often late, with referrals seemingly driven by the imminence of death rather than metastatic diagnosis. Strategies to better identify and triage specialty palliative care needs and make timely referrals are needed.

Keywords: End-of-life; Metastatic; Palliative care; Supportive care.