Concurrent uptake of palliative care has remained low in young adults with advanced cancers, according to the results of a retrospective cohort study published in JAMA Network Open.
“Palliative care can help address symptoms, support decision-making, and improve quality of life during treatment, yet many young adults are still not receiving these services,” said lead study author Kewei Sylvia Shi, MPH, Associate Scientist, Health Services Research at the American Cancer Society. “We need to get this population the care they need, especially as rates of early-onset cancers continue to increase.”
Background and Study Methods
Researchers conducted a retrospective cohort study based on the National Cancer Database, including patients who were newly diagnosed with their first primary stage IV solid tumor or poor-prognosis high-grade brain tumors; all patients (n = 67,706) were between the ages of 18 and 39 years and were diagnosed between 2010 and 2023. Patients who survived for less than 30 days were excluded to allow for enough time to initiate palliative treatment, as well as patients with missing demographic or treating facility information, and patients receiving palliative care without cancer-directed therapy.
The National Cancer Database defined palliative care as any care to alleviate symptoms, such as palliative-intent surgery, radiation therapy, or systemic therapy, as well as pain management and other nonprocedural supportive care.
The researchers compared cancer-directed systemic therapy with or without palliative care during the patient's first course of treatment.
Key Findings
Palliative care given concurrently with cancer-directed systemic therapy was utilized at low rates in all years in the study period, but the rate increased from 9.3% in 2010 to 18.3% in 2023.
Concurrent palliative care was highest among patients diagnosed with lung (39.1%; 95% confidence interval [CI] = 35.9%–42.4%), gastric (32.6%; 95% CI = 29.1%–36.2%), kidney (29.9%; 95% CI = 24.8%–35.6%), female breast (28.2%; 95% CI = 26.3%–30.2%), and pancreatic cancers (27.6%; 95% CI = 23.2%–32.4%). Palliative care use was lowest among patients with Hodgkin lymphoma (1.9%; 95% CI = 1.4%–2.7%), non-Hodgkin lymphoma (4.1%; 95% CI = 3.3%–5.0%), poor-prognosis brain tumors (4.3%; 95% CI = 3.4%–5.5%), and head and neck cancers (4.4%; 95% CI = 3.0%–6.4%).
“Cancer profoundly disrupts the lives of young adults. Beyond its physical effects, it can impact relationships, education, and plans for the future. As palliative care clinicians, it’s our role to walk alongside patients and families and understand their values and goals so we can ease the physical and emotional burdens of cancer,” said Arif Kamal, MD, MBA, MHS, Chief Patient Officer at the American Cancer Society and a palliative medicine specialist. “Palliative care should be integrated into oncology care for all people with cancer, no matter their age. And research has consistently shown that when palliative care and oncology teams work together, we can provide the best possible treatment while making sure it reflects what matters most to each patient. This is what compassionate cancer care is about: seeing the person beyond the diagnosis and making sure no one has to face the hardest parts of cancer alone.”
“This research highlights the pressing need for policies that will improve access to palliative care services for patients with cancer, especially for young adults, who often face unique challenges over the course of their cancer journey,” said Lisa Lacasse, President of the American Cancer Society Cancer Action Network. “We are urging Congress to pass the Palliative Care and Hospice Education and Training Act, which would improve patients’ access to quality palliative care services while expanding palliative care research funding and training tomorrow’s workforce to provide comprehensive care that treats the whole person.”
DISCLOSURES: For full disclosures of the study authors, visit jamanetwork.com.
