Abstract B011: Trends and racial/ethnic disparities in palliative care use among patients with de novo metastatic breast cancer – National Cancer Database, 2004-2020
Authors: Freeman Jincong Q. , Omoleye Olasubomi J. , Zhao Fangyuan , Huo Dezheng 
Published: December 2023

Abstract
Background: Palliative care improves the quality of life of patients with advanced cancers. However, despite current ASCO recommendations for the early integration of palliative care into oncology services, palliative care remains underutilized. Research into the utilization of palliative care among de novo metastatic breast cancer (dnMBC) patients is limited, in particular regarding national trends and racial/ethnic disparities. Methods: We analyzed data collected from dnMBC patients in the National Cancer Database (NCDB, 2004-2020). In NCDB, palliative care was defined as surgery, radiotherapy, systemic therapy, or other pain management with the purpose of controlling pain and alleviating symptoms or side effects of cancer treatment. We examined trends in palliative care utilization, overall and across racial/ethnic groups including non-Hispanic (NH) Asian or Pacific Islander (API), NH American Indian, Alaska Native, or other (AIANO), NH Black, Hispanic, and NH White. Multivariable logistic regression was used to assess racial/ethnic differences in palliative care use, adjusting for key demographic and clinical characteristics. Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Results: Of 148,931 dnMBC patients, the mean age was 62.3 years (SD=14.2); most (72.4%) were NH White, followed by 16.9% NH Black, 5.9% Hispanic, 3.0% NH API, and 1.8% NH AIANO. Overall, 20.7% of the patients used palliative care, with a significant increase from 14.9% in 2004 to 27.6% in 2020 (P for trend &lt;0.001). Palliative care utilization varied significantly by race/ethnicity (P &lt;0.001): 21.4% of NH White patients, 20.8% of NH AIANO patients, 20.0% of NH Black patients, 17.7% of NH API patients, and 16.0% of Hispanic patients used palliative care. The utilization of palliative care also increased significantly from 2004 to 2020 across all racial/ethnic groups. In the adjusted logistic regression model, NH Black (AOR=0.87; 95% CI: 0.84-0.91), API (AOR=0.74; 95% CI: 0.68-0.81), and Hispanic (AOR=0.65; 95% CI: 0.61-0.70) patients had lower odds of palliative care use than NH White patients. No statistically significant differences in palliative care use between AIANO and NH White patients were observed (AOR=0.97; 95% CI: 0.88-1.08). Conclusions: In this large, multiethnic national cohort of dnMBC patients, there was a significant increase in palliative care utilization from 2004 to 2020, though its utilization remained suboptimal. Patients of racial/ethnic minority groups were less likely to have used palliative care than their White counterparts. Our findings suggest a need to improve the utilization of, and equitable access to, palliative care services among dnMBC patients, particularly among racial/ethnic minority groups.
Citation Format: Jincong Q. Freeman, Olasubomi J. Omoleye, Fangyuan Zhao, Dezheng Huo. Trends and racial/ethnic disparities in palliative care use among patients with de novo metastatic breast cancer – National Cancer Database, 2004-2020 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B011.