Abstract PR03: Racial and health care access disparities in palliative care receipt among patients with advanced non-small cell lung cancer: An analysis of the 2016 National Cancer Database
Authors: Islam Jessica Y. , Braithwaite Dejana , Zhang Dongyu , Tailor Tina D. , Akinyemiju Tomi 
Published: December 2020

Abstract
Background: Early intervention with palliative care (PC) improves quality of life and increases survival among patients with advanced-stage non-small cell lung cancer (aNCSLC). However, PC is often offered late in the cancer care continuum and is underused. Few studies have examined racial disparities or evaluated the role of access to care in PC use among diverse aNCSLC patients. Objective: To determine the prevalence of PC use among aNSCLC patients by race/ethnicity and assess the role of healthcare access in PC disparities 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) who were deceased based on vital status on last contact (n=803,618). Based on the NCCN guidelines, PC includes surgery, radiation, chemotherapy, pain management or any combination with non-curative intent. We examined PC utilization rates by sociodemographic and health care access characteristics, and estimated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression to evaluate the independent associations of race/ethnicity and health care access with PC. Covariate adjustment sets for racial disparities and health care access factor analyses varied by exposure determined using directed acyclic graphs. Results: Our population was 55% male and 77% NH-White, with a mean age of 68 years. Overall, 20% of aNSCLC patients received any PC, while 6% received pain management. Compared to non-Hispanic (NH)-White patients, NH-Black (aOR: 0.91, 95% CI: 0.90-0.93) and Hispanic patients (aOR: 0.80, 9%% CI: 0.77-0.83) were less likely to receive PC after adjustment for socio-demographic and clinical variables. However, American Indian/Alaskan Native (aOR: 1.12, 95% CI: 1.01-1.24) and Native Hawaiian/Pacific Islander (aOR: 2.04, 95% CI:1.79-2.33) were significantly more likely to receive PC. Overall, compared to privately insured patients, uninsured patients (aOR: 1.14, 95% CI: 1.10-1.17) and Medicaid patients (aOR: 1.16, 95% CI: 1.14-1.19) were more likely to receive PC, while patients treated at a community cancer program (aOR: 0.89, 95% CI: 0.87-0.91) were less likely to receive PC compared with those treated at Comprehensive Cancer programs. Treatment at an integrated network cancer program was associated with increased likelihood of PC use (aOR: 1.12, 95% CI: 1.11-1.14). When stratified by race/ethnicity, the associations between healthcare access and PC utilization was consistent across race/ethnic groups. Notably, Asian patients were more likely to receive PC at all types of cancer treatment facilities compared to NH-White patients. Conclusion: NH-Black and Hispanic patients with aNSCLC are less likely to receive palliative care, a disparity that may be associated with insurance type and type of cancer treatment facility. Strategies to enhance palliative care utilization among underserved patients with aNSCLC should be identified in order to improve quality of life and survival.
Citation Format: Jessica Y. Islam, Dejana Braithwaite, Dongyu Zhang, Tina D. Tailor, Tomi Akinyemiju. Racial and health care access disparities in palliative care receipt among patients with advanced non-small cell lung cancer: An analysis of the 2016 National Cancer Database [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR03.