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Geographic variation in palliative care delivery among patients diagnosed with metastatic lung cancer in the USA: Medicare population-based study

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Abstract

Purpose

The USA has observed a significant increase in the use of palliative care for patients diagnosed with advanced cancer. However, it is unknown how geographic variation affects patients’ use of palliative care services. We examined temporal and demographic trends in receipt of and timing of palliative care by state and region.

Methods

A retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Study sample included community-dwelling patients aged ≥ 65 years with metastatic lung cancer who were diagnosed between 2001 and 2015. Cochran-Armitage trend test was used to evaluate temporal trends in receipt of and timing of palliative care by states and census region.

Results

The proportion of metastatic lung cancer patients who received palliative care ranged from 16.4% in Washington and 16.3% in Connecticut to 6.4% in Louisiana. From 2001 to 2015, use of palliative care increased from 3.2 to 29.8% in the West region, from 3.3 to 31.9% in the Northeast region, from 3.8 to 36.2% in the Midwest region, and from 0.9 to 23.3% in the South region (all P < 0.001). The median time from the date of cancer diagnosis to the date of first palliative care visit varied geographically, from 44 days in Utah to 66 days in California. Hospital-based palliative care was most common in these states.

Conclusion

The substantial geographic variation in the use of palliative care suggesting a need for additional research on geographic disparities in palliative care and strategies that might improve state-level palliative care delivery.

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Acknowledgments

We acknowledge that the study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services (IMS), Incorporated; and the SEER Program registries in the creation of the SEER-Medicare database. This manuscript has been approved by IMS as compliant with the database user agreement.

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Author notes

  1. Jinhai Huo and Young-Rock Hong contributed equally.

Authors and Affiliations

  1. Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, HPNP 3111, PO Box 100195, Gainesville, FL, 32610, USA

    Jinhai Huo, Young-Rock Hong & Kea Turner

  2. Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA

    Cheng Chen

  3. Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA

    Yi Guo & Jiang Bian

  4. Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA

    Diana J. Wilkie

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  1. Jinhai Huo
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  7. Jiang Bian
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Correspondence to Young-Rock Hong.

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This study was approved by the Institutional Review Board at the University of Florida.

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The authors declare that they have no competing interests.

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Huo, J., Hong, YR., Turner, K. et al. Geographic variation in palliative care delivery among patients diagnosed with metastatic lung cancer in the USA: Medicare population-based study. Support Care Cancer 29, 813–821 (2021). https://doi.org/10.1007/s00520-020-05549-z

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  • DOI: https://doi.org/10.1007/s00520-020-05549-z

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