Early Palliative Care Among Patients Diagnosed with Advanced Cancers Between 2010–2019 in the USA: Trends and Contribution of Provider Variation - European Medical Journal

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Early Palliative Care Among Patients Diagnosed with Advanced Cancers Between 2010–2019 in the USA: Trends and Contribution of Provider Variation

1 Mins
Oncology
Authors:
*Xin Hu,1 Youngmin Kwon,2 Charles Jiang,3 Qinjin Fan,4 Kewei Sylvia Shi,4 Zhiyuan Jason Zheng,4 Jingxuan Zhao,4 Joan Warren,5 K. Robin Yabroff,4 Xuesong Han4
  • 1. University of Virginia School of Medicine, Charlottesville, USA
  • 2. University of Pittsburgh School of Public Health, Virginia, USA
  • 3. UT Southwestern Medical Center, Dallas, Texas, USA
  • 4. American Cancer Society, Atlanta, Georgia, USA
  • 5. American Cancer Society, Atlanta, Georgia, USA (Retired)
*Correspondence to [email protected]
Disclosure:

Hu received a grant from the PhRMA Foundation and St. Jude Children’s Research Hospital. Yabroff has served on the Flatiron Health Equity Advisory Board and received honoraria from the National Comprehensive Cancer Network (NCCN). All other authors declared no conflicts of interest.

Acknowledgements:

The authors acknowledge the efforts of the National Cancer Institute (NCI); the Office of Research, Development and Information (ORDI), Centers for Medicare & Medicaid Services (CMS); Information Management Services (IMS); and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

The collection of cancer incidence data used in this study was supported by the California Department of Public Health according to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the NCI’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, USA, contract HHSN261201800015I awarded to the University of Southern California, Los Angeles, USA, and contract HHSN261201800009I awarded to the Public Health Institute, Oakland, California, USA. The ideas and opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the State of California, Department of Public Health, the NCI, or the CDC, or their contractors and subcontractors.

Citation:
Oncol AMJ. ;1[1]:39-41. https://doi.org/10.33590/oncolamj/TGQE1110.
Keywords:
Early palliative care, cancer care, provider practice variation, organization structures.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

Early integration of palliative care (PC) is recommended for advanced cancers given its clinical benefits for quality of life and survival, but evidence of its use and the role of provider practice patterns and organizational characteristics in uptake is limited.1 This study examined recent trends of early PC among Medicare beneficiaries newly diagnosed with advanced cancers, and provider- and organization-variation in the receipt of early PC.

MATERIAL AND METHODS

The authors identified patients aged ≥65.5 years newly diagnosed with advanced-stage breast, colorectal, non-small cell lung, small cell lung, pancreatic, and prostate cancers in 2010–2019 with ≥6 months survival and continuous fee-for-service coverage from the linked SEER-Medicare data. Early PC was identified by claims with corresponding diagnosis codes or hospice and palliative medicine provider specialty codes within 90 days post-diagnosis or up to the first hospice admission date (whichever came earlier).2 Treating physicians and corresponding organizations (i.e., Tax Identification Number) were assigned based on the plurality of visits with a cancer diagnosis code within 180 days surrounding cancer diagnosis date. The team described the percentage of patients receiving early PC each year overall and stratified by cancer type. To evaluate the contribution of provider variation in early palliative care use, they first conducted generalized linear probability models with physician- and organization-fixed effects to estimate the proportion of variation in early PC receipt due to between-physicians/organizations variation. The association between several observable physician and organization characteristics and early PC receipt was then estimated. All regression models were also controlled for patient socio-demographic and clinical characteristics.

RESULTS

Among 102,060 patients treated by 19,186 unique providers and 8,039 organizations, the percentage receiving early PC increased from 1.4% to 10.3% in 2010–2019. Although statistically significant increases were observed across cancer types, receipt in patients with prostate cancer was relatively lower compared to pancreatic, small cell lung, non-small cell lung, and breast cancers (Table  1). After adjusting for patients’ characteristics, variation in early PC use between treating physicians and organizations explained 48.2% and 32.7% of the total variation, respectively. Among observable physician and organization characteristics, treating physicians’ early PC referral in the past year (6.76 percentage points; 95% CI: 5.54–7.98) and treating organizations’ employment of hospice and PC specialists (3.18 percentage points; 95% CI: 2.59–3.77) were most strongly associated with early PC receipt.

Table 1: Percent of early palliative care receipt among patients with advanced cancers.
N: number; NSCLC: non-small cell lung cancer; SCLC: small cell lung cancer.

CONCLUSION

Despite considerable growth in early PC receipt, utilization remained low in 2019. The large variation between providers and organizations suggests important modifiable provider behaviours and organizational characteristics in early PC use. In particular, education to increase awareness and referral to early PC among physicians and efforts to increase hospice and palliative medicine workforce may be effective tools to promote early PC utilization.

References
Ferrell BR 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. Huo J et al. Timing, costs, and survival outcome of specialty palliative care in medicare beneficiaries with metastatic non-small-cell lung cancer. JCO Oncol Pract. 2020;16(12):e1532-42.

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