Abstract P6-05-04: Patterns in palliative care use and their impact on survival in the elderly metastatic breast cancer (MBC) population: a National Cancer Database (NCDB) Analysis
Authors: Patel Rima , Kwon Deukwoo , Hovstadius Malin , Tiersten Amy 
Published: March 2023

Background: About 6% of patients diagnosed with breast cancer (BC) will have metastatic disease at time of diagnosis. In this case, treatment is palliative and focused on systemic therapies. Both American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend early integration of palliative care (PC) for patients with metastatic disease to improve symptom management and quality of life while potentially decreasing mortality. However, the frequency by which elderly patients with metastatic breast cancer (MBC) receive PC is unknown. This is especially relevant as improvements in health care have allowed for longer life expectancy and an increase in America’s aged population. The goal of this study was to use the NCDB to describe national patterns in PC use in elderly patients over 75 years of age with MBC and evaluate differences in overall survival (OS).

Methods: Women with a diagnosis of BC at age &gt;/= 75 years and with metastases at time of initial diagnosis from 2010 to 2019 were identified from the NCDB. Patients were stratified into age subgroups of 75-79, 80-84, and &gt;/= 85 years. Chi-square tests were used to compare categorical variables. Kaplan Meier curves were used to determine OS distributions for patients by age and receipt of PC. Log-rank tests and multivariable cox proportional hazards modeling was performed to assess the difference in OS between patients who received and did not receive PC.

Results: Of 17,325 eligible women included in the final analysis, 39.4% were 75-79, 30.1% 80-84, and 30.4% &gt;/= 85 years of age. Overall, 20.5% of patients utilized PC. The table below describes the baseline characteristics of patients who received PC versus those who did not. Rates of PC utilization varied among the age subgroups, with the lowest utilization in the &gt;/= 85 years of age group, p&lt; 0.0001. Performance status as measured by Charlson-Deyo Score did not impact rates of PC use, p=0.3196. Use of PC varied across races with higher use in Non-Hispanic White patients and lower in Hispanic and Non-Hispanic Black subgroups, p&lt; 0.0001. In the overall population, the use of PC increased from 17.9% in 2010 to 23.2% in 2019, p=0.0003. This was primarily driven by the statistically significant increase in the 75-79 age group (18.4% to 26.8%, p=0.0003). Although there were numeric increases in PC use from 2010 to 2019 in the 80-84 (20.9% to 24%, p=0.2899) and &gt;/= 85 (13.9% to 17.9%, p=0.1082) age groups, these differences were not statistically significant. Palliative care receipt did not impact overall survival. Three-year OS rates were 27.8% (CI: 26.1-29.5) and 27.8% (CI: 27.0-28.7), for patients who received PC compared to those who did not, respectively, p=0.512.

Conclusions: Over the last decade, we observed an increase in PC utilization in patients &gt;/= 75 years with MBC. However, significant increases were only seen in the 75-79 age group. Palliative care use was lower among patients &gt;/= 85 years compared to those 75-79 or 80-84 years of age. Performance status did not influence receipt of PC. There were no differences in OS between elderly patients who received PC versus those who did not. Future follow up analyses will be needed to determine the impact of PC on OS in this population. Clinicians should be encouraged to integrate PC into the treatment of elderly patients with MBC, particularly those &gt;/= 85 years, as this can improve symptoms and quality of life.

Table 1. Patient Baseline Characteristics by Palliative Care Receipt.

Citation Format: Rima Patel, Deukwoo Kwon, Malin Hovstadius, Amy Tiersten. Patterns in palliative care use and their impact on survival in the elderly metastatic breast cancer (MBC) population: a National Cancer Database (NCDB) Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-04.