Socioeconomic and racial/ethnic disparities in receipt of palliative care among patients with metastatic hepatocellular carcinoma.
Aged
Carcinoma, Hepatocellular
/ economics
Combined Modality Therapy
Ethnicity
/ statistics & numerical data
Female
Follow-Up Studies
Healthcare Disparities
Humans
Liver Neoplasms
/ economics
Male
Middle Aged
Palliative Care
Prognosis
Quality of Life
Retrospective Studies
Socioeconomic Factors
Survival Rate
hepatocellular carcinoma
palliative care
racial/ethnical disparities
socioeconomic disparities
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
revised:
05
08
2021
received:
01
07
2021
accepted:
28
08
2021
pubmed:
11
9
2021
medline:
24
11
2021
entrez:
10
9
2021
Statut:
ppublish
Résumé
Patients with metastatic hepatocellular carcinoma (HCC) suffer symptoms of both end-stage liver disease and cancer. Palliative care (PC) enhances the quality of life via symptom control and even improves survival for some cancers. Our study characterized rates of PC utilization among metastatic HCC patients and determined factors associated with PC receipt. We conducted a retrospective review of adult National Cancer Database patients diagnosed with metastatic HCC between 2004 and 2016. Chi-square tests were used to analyze two cohorts: those who received PC and those who did not. Logistic regression was performed to assess the impact of clinicodemographic factors on the likelihood of receiving PC. PC utilization was low at just 17%. Later year of diagnosis, insured status, and higher education level were associated with an increased likelihood of receiving PC. Treatment at academic centers or integrated network cancer programs increased the likelihood of receiving PC compared to treatment at a community center (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.03-1.33 and OR = 1.25, 95% CI = 1.07-1.45; respectively). Hispanics were significantly less likely to received PC than non-Hispanic Whites (OR = 0.73, 95% CI = 0.64-0.82). PC utilization among patients with metastatic HCC remains low. Targeted efforts should be enacted to increase the delivery of PC in this group.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with metastatic hepatocellular carcinoma (HCC) suffer symptoms of both end-stage liver disease and cancer. Palliative care (PC) enhances the quality of life via symptom control and even improves survival for some cancers. Our study characterized rates of PC utilization among metastatic HCC patients and determined factors associated with PC receipt.
METHODS
METHODS
We conducted a retrospective review of adult National Cancer Database patients diagnosed with metastatic HCC between 2004 and 2016. Chi-square tests were used to analyze two cohorts: those who received PC and those who did not. Logistic regression was performed to assess the impact of clinicodemographic factors on the likelihood of receiving PC.
RESULTS
RESULTS
PC utilization was low at just 17%. Later year of diagnosis, insured status, and higher education level were associated with an increased likelihood of receiving PC. Treatment at academic centers or integrated network cancer programs increased the likelihood of receiving PC compared to treatment at a community center (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.03-1.33 and OR = 1.25, 95% CI = 1.07-1.45; respectively). Hispanics were significantly less likely to received PC than non-Hispanic Whites (OR = 0.73, 95% CI = 0.64-0.82).
CONCLUSIONS
CONCLUSIONS
PC utilization among patients with metastatic HCC remains low. Targeted efforts should be enacted to increase the delivery of PC in this group.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1365-1372Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2020;71(3):209-249.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90.
Ho DW, Lo RC, Chan LK, Ng IO. Molecular pathogenesis of hepatocellular carcinoma. Liver Cancer. 2016;5(4):290-302.
Ioannou GN, Weiss NS, Kowdley KV. Relationship between transferrin-iron saturation, alcohol consumption, and the incidence of cirrhosis and liver cancer. Clin Gastroenterol Hepatol. 2007;5(5):624-629.
Abbas A, Medvedev S, Shores N, et al. Epidemiology of metastatic hepatocellular carcinoma, a nationwide perspective. Dig Dis Sci. 2014;59(11):2813-2820.
Natsuizaka M, Omura T, Akaike T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol. 2005;20(11):1781-1787.
(WHO), W.H.O. Palliative Care. 2021. https://www.who.int/health-topics/palliative-care
Zhao X-X, Cui M, Geng YH, Yang YL. A systematic review and meta-analysis of randomized controlled trials of palliative care for pain among Chinese adults with cancer. BMC Palliat Care. 2019;18(1):69.
Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749.
Yennurajalingam S, Urbauer DL, Casper KL, et al. Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. J Pain Symptom Manage. 2011;41(1):49-56.
Vanbutsele G, Pardon K, Van Belle S, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncol. 2018;19(3):394-404.
Greer JA, El-Jawahri A, Pirl WF, et al. Randomized trial of early integrated palliative and oncology care. J Clin Oncol. 2016;34(26_suppl):S104.
Sullivan DR, Chan B, Lapidus JA, et al. Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the veterans health administration. JAMA Oncol. 2019;5(12):1702-1709.
Hammad AY, Robbins JR, Turaga KK, Christians KK, Gamblin TC, Johnston FM. Palliative interventions for hepatocellular carcinoma patients: analysis of the National Cancer Database. Ann Palliat Med. 2017;6(1):26-35.
Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96-112.
Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliative Med. 2018;21(12):1684-1689.
Cole AP, Nguyen DD, Meirkhanov A, et al. Association of care at minority-serving vs non-minority-serving hospitals with use of palliative care among racial/ethnic minorities with metastatic cancer in the United States. JAMA Netw Open. 2019;2(2):e187633.
Ju MR, Paul S, Polanco P, et al. Underutilization of palliative care in metastatic foregut cancer patients is associated with socioeconomic disparities. J Gastrointest Surg. 2020;25:1404-1411.
Smith CB, Phillips T, Smith TJ. Using the new ASCO clinical practice guideline for palliative care concurrent with oncology care using the TEAM approach. Am Soc Clin Oncol Educ Book. 2017;37:714-723.
Ahmed F, Perz JF, Kwong S, Jamison PM, Friedman C, Bell BP. National trends and disparities in the incidence of hepatocellular carcinoma, 1998-2003. Prev Chronic Dis. 2008;5(3):A74.
Siegel RL, Fedewa SA, Miller KD, et al. Cancer statistics for Hispanics/Latinos. CA Cancer J Clin. 2015;65(6):457-480.
Kuftinec GN, Levy R, Kieffer DA, Medici V. Hepatocellular carcinoma and associated clinical features in Latino and Caucasian patients from a single center. Ann Hepatol. 2019;18(1):177-186.
Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol. 2013;47:S2-S6.
El-Serag HB, Lau M, Eschbach K, Davila J, Goodwin J. Epidemiology of hepatocellular carcinoma in Hispanics in the United States. Arch Intern Med. 2007;167(18):1983-1989.
Huo J, Hong YR, Grewal R, et al. Knowledge of palliative care among American adults: 2018 health information national trends survey. J Pain Symptom Manage. 2019;58(1):39-47.
Kronebusch K, Gray BH, Schlesinger M. Explaining racial/ethnic disparities in use of high-volume hospitals: decision-making complexity and local hospital environments. Inquiry. 2014;51:51.
Bureau USC. Health Insurance Coverage in the United States: 2019. 2020.
Cole AP, Nguyen DD, Meirkhanov A, et al. Association of care at minority-serving vs non-minority-serving hospitals with use of palliative care among racial/ethnic minorities with metastatic cancer in the United States. JAMA Netw Open. 2019;2(2):e187633.
Kamal AH, Bull JH, Swetz KM, Wolf SP, Shanafelt TD, Myers ER. Future of the palliative care workforce: preview to an impending crisis. Am J Med. 2017;130(2):113-114.
Dumanovsky T, Augustin R, Rogers M, Lettang K, Meier DE, Morrison RS. The growth of palliative care in U.S hospitals: a status report. J Palliat Med. 2016;19(1):8-15.
Allen Watts K, Malone E, Dionne-Odom JN, et al. Can you hear me now?: improving palliative care access through telehealth. Res Nurs Health. 2021;44:226-237.
Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343-380