Palliative care utilization in metastatic prostate cancer: An analysis of the National Cancer Database. Issue 28 (1st October 2022) - Wu, Xinxin
Abstract : 202 Background: Prostate cancer is one of the most prevalent cancers among males with an increasing incidence rate since 2007. Bone metastases are commonly associated with prostate cancer. Prostate cancer patients with painful bone metastases can be treated palliatively with external radiation being the standard of care. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course even after intensive multimodal therapy. There has yet to be a study that explores the impact of race, insurance status, education level, facility type, rural/urban geography, and income level on the overall utilization of palliative care for the cancer, the palliative treatment the patients were more likely to receive based on the different demographic variables, and the palliative care disparity between socioeconomic groups. Methods: This is a retrospective study of adults diagnosed with all subtypes of AJCC staged metastatic prostate cancer between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 64, 268). Demographic factors were studied in relation to the receipt of palliative care. Cross tabulation analysis was performed and evaluated using Pearson Chi-Square and ANOVA tests. Kaplan-Meier curves were utilized to calculate survival probabilities with log-rank analysis. Exclusion criteria included concurrent tumors and missing data. Results: Approximately 15.8% of the patients diagnosed with metastatic prostate cancer received palliative care (10180/64268). The number of cases diagnosed has grown every year between 2004 (n = 2140) and 2017 (n = 6, 961). The same pattern was seen for palliative care usage in these patients (n = 352 in 2004 and n = 1325 in 2017). The patients that did not receive palliative care were older (71.3 vs 70.7, range 40-90+, p < 0.001). The patients who did receive PC were more likely to be non-Hispanic (94.6%, p < 0.001), white (78.6%, p < 0.001) patients at a comprehensive community cancer program (40.9%, p < 0.001). Palliative care was more likely utilized in rural settings (2% vs 1.6%, p < 0.001), higher Charlson-Deyo score (0.41 vs 0.38, p < 0.001), all facility locations excluding Mountain or Pacific, lower levels of high school degree attainment, lower overall survival, and those in age groups ranged 40-49, 50-59, and 60-69. There was no statistical significant difference in great circle distance between those that utilized palliative care and those that did not. Conclusions: We identified trends among patients receiving palliative or not. Factors that were correlated with palliative care usage included race, Charlson-Deyo score, treatment facility type, region, education level, rural setting, and specific age groups. As palliative care continues to be utilized more frequently, we hope that this study can serve as a useful baseline for preventing disparities in care.