Racial and ethnic inequities of palliative care use among advanced Non-Small cell lung cancer patients in the US.
Cancer Med
; 12(7): 8567-8580, 2023 04.
Article
en En
| MEDLINE
| ID: mdl-36533434
ABSTRACT
BACKGROUND:
With early intervention, palliative care (PC) can improve quality of life and increase survival among advanced-stage non-small cell lung cancer (aNCSLC) patients. However, PC is often offered late in the cancer treatment course and is underused. We characterized racial/ethnic inequities and the role of healthcare access in PC use among patients with aNSCLC.METHODS:
We used data from the 2004-2016 National Cancer Database, including adults aged 18-90 years with aNSCLC (stage 3 or 4 at diagnosis; n = 803,618). Based on the NCCN guidelines, PC includes non-curative surgery, radiation, chemotherapy, pain management, or any combination of non-curative care. We examined PC use by sociodemographic and health care-level characteristics. To evaluate the independent associations of race/ethnicity and health care access characteristics with PC, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Covariate adjustment sets varied by exposure determined using directed acyclic graphs.RESULTS:
Our population was 55% male and 77% non-Hispanic/Latinx (NH)-White, with a mean age of 68 years. Overall, 19% of patients with aNSCLC used PC. Compared to NH-White patients, NH-Black (aOR0.91,95% CI0.89-0.93) and Hispanic/Latinx (aOR0.80,95% CI0.77-0.83) patients were less likely to use PC, whereas Indigenous (AI/AN) (aOR1.18,95% CI1.06-1.31) and Native Hawaiian/Pacific Islander (aOR2.08,95% CI1.83-2.36) patients were more likely. Overall, compared to the privately-insured, uninsured (aOR1.19,95% CI1.11-1.28) and Medicaid-insured patients (aOR1.19,95% CI1.14-1.25) were more likely to use PC.CONCLUSION:
PC is underutilized among NH-Black and Hispanic/Latinx patients with aNSCLC. Insurance type may play a role in PC use among patients with aNSCLC.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Carcinoma de Pulmón de Células no Pequeñas
/
Neoplasias Pulmonares
Tipo de estudio:
Guideline
Aspecto:
Patient_preference
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Cancer Med
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos