Abstract 5528: Palliative and end of life care utilization in Asian and White patients with stage IV lung cancer
Authors: Hu Xiao , Melson John W. , Pan Stacey , Salei Yana , Cao Yu 
Published: April 2023

Abstract
Background: Lung cancer (LC) is the leading cause of cancer death in Asian Americans, the fastest growing racial/ethnic group in the US. Early palliative care (PC) is recommended for patients with stage IV LC. Research on PC and end of life care (EOLC) for Asian patients (AP) with stage IV LC in the US is limited. This retrospective study examines racial influences on PC and EOLC in patients with stage IV LC at an urban academic medical center serving a large proportion of AP.
Methods: Patients newly diagnosed with stage IV LC from 01/01/2014 to 12/31/2019 were identified from Tufts Medical Center cancer registry. Baseline demographics, disease characteristics, treatment history, PC and hospice use, and EOLC were compared between AP and White patients (WP) by Mann-Whitney U test and Chi-square/Fisher's exact tests for continuous and categorical variables, respectively. Time to palliative care (TTPC) in AP and WP was compared via log-rank test.
Results: Of 89 AP and 197 WP (similar median age: 71 and 68 years old, respectively), AP had significantly more male representation (71.9% vs 48.2%), never-smokers (36.0% vs 7.1%), non-small cell histology (85.4% vs 72.6%), linguistic diversity (non-English languages: 6 vs 2), and interpreter use (43.8% vs 0.5%), with less preference for English (12% vs 99%). No difference in brain metastasis at diagnosis was noted. PC use was similar in AP and WP (38.2% vs 37.6%); relatively more first encounters occurred inpatient vs outpatient in both groups. Median TTPC tended to be longer in AP (15.7 vs 12.4 months, p=0.120). PC evaluation occurred within 12 months after diagnosis in 27 (30.3%) AP and 63 (32.0%) WP. Of those seen by PC, only 7 (20.6%) AP and 16 (21.3%) WP had more than one PC encounter. Of 22 AP and 74 WP with confirmed death, relatively more AP patients died in hospital (68.2% vs 32.4%, p=0.004), more often in ICU (40.9% vs 24.3%); no differences were found in use of mechanical ventilation (18.2% vs 16.2%) or cardiopulmonary resuscitation (0% vs 1.4%) preceding death. Within 6 months of death, outpatient oncologists and AP patients had fewer code status (0% vs 24.3%, p=0.010) but similar rates of health care proxy (18.2% vs 32.4%, p=0.110) and hospice care (18.2% vs 28.4%, p=0.411) discussions. Hospice enrollment (29.2% vs 32.0%, p=0.722), median time from entering hospice to death (16.5 vs 12.5 days, p=0.795) and from last systemic treatment to death (39 vs 55.5 days, p=0.844) were similar in AP and WP.
Conclusion: PC utilization was similarly sub-optimal in AP and WP with newly diagnosed stage IV LC in this study, though TTPC tended to be longer in AP. While hospice utilization was also similar in AP and WP, AP had a higher rate of in-hospital death and fewer code status discussions with their outpatient oncologists in the 6 months preceding death. Whether these findings reflect racial disparities, cultural preferences, or other factors influencing PC and EOLC for AP with advanced LC warrants further study.
Citation Format: Xiao Hu, John W. Melson, Stacey Pan, Yana Salei, Yu Cao. Palliative and end of life care utilization in Asian and White patients with stage IV lung cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5528.