Despite a steady increase in palliative care utilization from 2004 to 2020, racial and ethnic minority patients with metastatic breast cancer may be less likely to receive palliative care compared with non-Hispanic White patients with the disease, according to new findings presented by Freeman et al at the 16th American Association for Cancer Research (AACR) Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (Abstract B011).
Background
The rapid integration of palliative care into patients’ care plans has been shown to improve their mood, quality of life, and overall survival. The National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) on palliative care recommended that all patients with cancer should be screened to determine their palliative care needs, both at intake and throughout treatment. Further, patients, families, and caregivers should be informed that palliative care is an integral part of their treatment.
“It is essential to identify the needs of these patients, particularly racial [and] ethnic minority populations, and evaluate how oncology programs can integrate palliative care early into the cancer care continuum while ensuring equitable access,” explained lead study author Jincong Freeman, MPH, MS, a doctoral student in the Department of Public Health Sciences at the University of Chicago.
Study Methods and Results
In the new study, investigators used the National Cancer Database to analyze the de-identified data of 148,931 patients with de novo metastatic breast cancer from 2004 to 2020—with the goal of better understanding palliative care utilization over time and across different racial and ethnic groups for patients with metastatic breast cancer. The investigators discovered that the use of palliative care increased significantly over time, from 14.9% in 2004 to 27.6% in 2020, across all racial and ethnic groups.
However, non-Hispanic Black patients, Asian or Pacific Islander patients, and Hispanic patients were 13%, 26%, and 35% less likely to receive palliative care, respectively, than non-Hispanic White patients after adjusting for clinical and sociodemographic factors. The investigators reported no statistically significant differences in the use of palliative care between non-Hispanic White patients, American Indian patients, Alaska Native patients, and other patients.
The investigators emphasized that despite the observed increases, palliative care use remained suboptimal. Over 70% of the patients involved in the study did not receive palliative care in 2020. While the National Cancer Database did not assess the reasons underlying skipped palliative care opportunities, the investigators speculated that lack of awareness, cultural beliefs, and physician preferences may have played a critical role.
Conclusions
The investigators stressed that more research may be needed to help illuminate the factors contributed to the low rate of palliative care uptake.
In order to further increase the use of palliative care across demographic groups, they suggested that physicians adhere to NCCN’s call to integrate palliative care early into the cancer care continuum for all patients and called on physicians and patients to dispel some of the myths and misunderstandings associated with palliative care—including confusing palliative care with hospice care or end-of-life care or assuming that it cannot be combined with active cancer treatment.
Limitations of the study included potential underreporting or misclassifications of palliative care in the National Cancer Database, necessitating future prospective studies to confirm the findings. Furthermore, while the investigators adjusted for clinical and sociodemographic factors, they did not have information on other factors such as patients’ symptoms or treatment side effects that may determine whether palliative care is necessary.
“Our findings underscore the importance of promoting the benefits of palliative care and addressing racial [and] ethnic disparities to improve the quality of life of [patients with] metastatic breast cancer,” Dr. Freeman concluded.
Disclosure: The research in this study was funded by the Breast Cancer Research Foundation, the National Cancer Institute of the National Institutes of Health, and the Susan G. Komen Breast Cancer Foundation.
