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Palliative care utilization and racial and ethnic disparities among women with de novo metastatic breast cancer in the United States

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Abstract

Purpose

The potential disparities in palliative care delivery for underrepresented minorities with breast cancer are not well known. We sought to determine whether race and ethnicity impact the receipt of palliative care for patients with metastatic breast cancer (MBC).

Methods

We retrospectively reviewed the National Cancer Database for female patients diagnosed with stage IV breast cancer between 2010 and 2017 who received palliative care following diagnosis of MBC to assess the proportion of patients who received palliative care, including non–curative-intent local–regional or systemic therapy. Multivariable logistic regression analysis was performed to identify variables associated with receiving palliative care.

Results

60,685 patients were diagnosed with de novo MBC. Of these, only 21.4% (n = 12,963) received a palliative care service. Overall, there was a positive trend in palliative care receipt from 18.2% in 2010 to 23.0% in 2017 (P < 0.001), which persisted when stratified by race and ethnicity. Relative to non-Hispanic White women, Asian/Pacific Islander women (aOR 0.80, 95% CI 0.71–0.90, P < 0.001), Hispanic women (adjusted odds ratio [aOR] 0.69, 95% CI 0.63–0.76, P < 0.001), and non-Hispanic Black women (aOR 0.94, 95% CI 0.88–0.99, P = 0.03) were less likely to receive palliative care.

Conclusions

Fewer than 25% of women with MBC received palliative care between 2010 and 2017. While palliative care has significantly increased for all racial/ethnic groups, Hispanic White, Black, and Asian/Pacific Islander women with MBC still receive significantly less palliative care than non-Hispanic White women. Further research is needed to identify the socioeconomic and cultural barriers to palliative care utilization.

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Data availability

The primary data set (National Cancer Database) is available publicly for investigators associated with the Commission on Cancer-accredited programs through the American College of Surgeons (https://www.facs.org/quality-programs/cancer/ncdb).

Data responsibility

Drs. Singh and Ma had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

Abbreviations

aHR:

Adjusted hazards ratio

aOR:

Adjusted odds ratio

API:

Asian or Pacific Islander

ASCO:

American society of clinical oncology

HW:

Hispanic White

MBC:

Metastatic breast cancer

NCDB:

National cancer database

NHB:

Non-Hispanic Black

NHW:

Non-Hispanic White

OS:

Overall survival

STROBE:

Strengthening the reporting of observational studies in epidemiology

US:

United States

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Acknowledgements

The authors wish to thank Jessica Kirwan, Amy Carrao-Tackett, and Sean Hess for editorial assistance that greatly improved the manuscript.

Funding

This research was supported by the National Cancer Institute Cancer Center Support Grant (P30CA016056). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication; Mailhot Vega is supported by NCATS UL1TR001427 KL2 award.

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Author notes

  1. Fantine Giap and Sung Jun Ma have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL, 32206, USA

    Fantine Giap, Raymond B. Mailhot Vega, Eric D. Brooks, Paul G. Okunieff, Nancy P. Mendenhall & Julie A. Bradley

  2. Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Sung Jun Ma & Anurag K. Singh

  3. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, 32224, USA

    Oluwadamilola T. Oladeru

  4. Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA

    Young-Rock Hong

  5. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Brian Yu

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  1. Fantine Giap
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Contributions

Study concept and design: JAB, OTO, FG, and SJM. Acquisition, analysis, or interpretation of data: JAB, OTO, FG, AKS, and SJM. Drafting of the manuscript: FG and SJM. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: SJM. Administrative, technical, or material support: AKS, JAB, and OTO. Supervision: JAB.

Corresponding author

Correspondence to Julie A. Bradley.

Ethics declarations

Competing interest

Bradley—ASCO/Pfizer research grant & Florida Breast Cancer Foundation research grant; Oladeru—Bristol Myers Squibb Foundation Grant, Radiation Oncology Institute and NRG Oncology; Singh—Astra-Zeneca-National Comprehensive Cancer Network grant, Department of Defense Translational Science Grant, P30 National Cancer Institute Grant; All other authors report no conflict of interest.

Ethical approval

Roswell Park Comprehensive Cancer Center institutional review board (BDR-131220) approved our study.

Disclaimer

The National Cancer Database is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The Commission on Cancer National Cancer Database and the hospitals participating in the program are the sources of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Giap, F., Ma, S.J., Oladeru, O.T. et al. Palliative care utilization and racial and ethnic disparities among women with de novo metastatic breast cancer in the United States. Breast Cancer Res Treat 200, 347–354 (2023). https://doi.org/10.1007/s10549-023-06963-7

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  • DOI: https://doi.org/10.1007/s10549-023-06963-7

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