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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Michelle R. Ju, Patricio Polanco, Mathew Augustine, John Mansour, Sam Wang & Matthew R. Porembka

  2. School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Subhadeep Paul

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  1. Michelle R. Ju
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  2. Subhadeep Paul
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All authors were involved in the formulation of research question, data analysis, and preparation of final manuscript.

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Correspondence to Matthew R. Porembka.

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None of the authors have conflicts of interest to disclose. SCW is a Disease Oriented Clinical Scholar at UTSW. MRP is a Dedman Family Scholar in Clinical Care at UTSW.

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Ju, M.R., Paul, S., Polanco, P. et al. Underutilization of Palliative Care in Metastatic Foregut Cancer Patients Is Associated with Socioeconomic Disparities. J Gastrointest Surg 25, 1404–1411 (2021). https://doi.org/10.1007/s11605-020-04742-z

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  • DOI: https://doi.org/10.1007/s11605-020-04742-z

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