Racial and ethnic disparities in palliative care utilization among gynecological cancer patients.
BACKGROUND
Palliative care (PC) is recommended for gynecological cancer patients to improve survival and quality-of-life. Our objective was to evaluate racial/ethnic disparities in PC utilization among patients with metastatic gynecologic cancer.


METHODS
We used data from the 2016 National Cancer Database (NCDB) and included patients between ages 18-90 years with metastatic (stage III-IV) gynecologic cancers including, ovarian, cervical and uterine cancer who were deceased at last contact or follow-up (n = 124,729). PC was defined by NCDB as non-curative treatment, and could include surgery, radiation, chemotherapy, and pain management or any combination. We used multivariable logistic regression to evaluate racial disparities in PC use.


RESULTS
The study population was primarily NH-White (74%), ovarian cancer patients (74%), insured by Medicare (47%) or privately insured (36%), and had a Charlson-Deyo score of zero (77%). Over one-third of patients were treated at a comprehensive community cancer program. Overall, 7% of metastatic gynecologic deceased cancer patients based on last follow-up utilized palliative care: more specifically, 5% of ovarian, 11% of cervical, and 12% of uterine metastatic cancer patients. Palliative care utilization increased over time starting at 4% in 2004 to as high as 13% in 2015, although palliative care use decreased to 7% in 2016. Among metastatic ovarian cancer patients, NH-Black (aOR:0.87, 95% CI:0.78-0.97) and Hispanic patients (aOR:0.77, 95% CI:0.66-0.91) were less likely to utilize PC when compared to NH-White patients. Similarly, Hispanic cervical cancer patients were less likely (aOR:0.75, 95% CI:0.63-0.88) to utilize PC when compared to NH-White patients.


CONCLUSIONS
PC is highly underutilized among metastatic gynecological cancer patients. Racial disparities exist in palliative care utilization among patients with metastatic gynecological cancer.
['Islam|Jessica Y|JY|', 'Deveaux|April|A|', 'Previs|Rebecca A|RA|', 'Akinyemiju|Tomi|T|']
D000293:Adolescent D000328:Adult D001741:African Americans D000368:Aged D000369:Aged, 80 and over D005260:Female D005500:Follow-Up Studies D005833:Genital Neoplasms, Female D054625:Healthcare Disparities D006630:Hispanic or Latino D006801:Humans D006278:Medicare D008875:Middle Aged D009367:Neoplasm Staging D010166:Palliative Care D010342:Patient Acceptance of Health Care D014481:United States D044465:Whites D055815:Young Adult
Palliative care Gynecologic cancers Uterine cancer Racial disparities Ovarian cancer Cervical cancer National Cancer Data Base