In a study reported in JCO Oncology Practice, Ferrario et al found that while use of palliative care among commercially insured patients aged 25 to 64 years in the United States with metastatic cancer has increased since 2001, use remained at 40% among patients with very poor–prognosis cancers in 2016.
As stated by the investigators, “Early palliative care, concomitant with disease-directed treatments, is recommended for all patients with advanced cancer. This study assesses population-level trends in palliative care use among a large cohort of commercially insured patients with metastatic cancer, applying an expanded definition of palliative care services based on claims data.”
Study Details
The study used nationally representative commercial insurance claims data to identify patients with metastatic breast, colorectal, lung, bronchial, tracheal, ovarian, esophageal, pancreatic, and liver cancers, as well as melanoma, between 2001 and 2016. Proportions of these patients who received services specified as or indicative of palliative care were calculated. Poor-prognosis cancers were defined as those with < 50% 5-year survival for the distal (metastatic) stage for patients up to age 64 years (including breast, colorectal, and ovarian cancers and melanoma). Very poor–prognosis cancers were defined as those with < 50% 5-year survival for both regional and distant stage for patients up to age 64 years (including liver, esophageal, pancreatic, lung, bronchial, and tracheal cancers).
Key Findings
A total of 64,412 patients were included in the analysis.
In 2016, palliative care services were used by 36% of patients with very poor–prognosis cancers and by 18% of patients with poor-prognosis cancers.
Between 2001 and 2008, the cumulative probability of having a first palliative care encounter within a year after a metastatic cancer diagnosis ranged from 11% for patients with colorectal cancer to 22% for those with esophageal cancer. Between 2009 and 2017, the cumulative probability of a first encounter within a year after diagnosis ranged from 19% for patients with colorectal cancer to 38% for liver cancer.
On multivariate analysis, factors associated with shorter time from diagnosis to palliative care were:
- Diagnosis in 2009 to 2016 vs 2001 to 2008 (hazard ratio [HR] = 1.8, P < .001)
- Compared with diagnosis of breast cancer, diagnosis of esophageal (HR = 1.89, P < .009), liver (HR = 1.84, P < .001), lung/bronchial/tracheal (HR = 1.56, P < .001), or pancreatic cancer (HR = 1.52, P < .001), or melanoma (HR = 1.42, P <. 001 )
- Greater number of comorbidities: compared with American Hospital Formulary Service class 0, class 4 to 6 (HR = 1.31, P < .001 ), 7 to 9 (HR = 1.51, P < .001) and > 10 (HR = 1.71, P < .001)
- Residence in the Northeast (HR = 1.43, P < .001) or Midwest (HR = 1.39, P < .001) vs South.
No significant difference was observed for age ≥ 50 to 59 years or ≥ 60 to 64 years vs age < 50 years.
The investigators concluded, “Use of palliative care among commercially insured patients with advanced cancers has increased since 2001. However, even with an expanded definition of services specified as, or indicative of, palliative care, < 40% of patients with advanced cancers received palliative care in 2016.”
Alessandra Ferrario, PhD, of the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
