Disparities among GU cancer patients referred to palliative care.
Authors: Saad Omar Atiq, James Helzberg, Nathan Hirshman, Zainab Atiq, Daniel J. George, Arif Kamal
Journal: Journal of Clinical Oncology (2021)

114 Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p &lt; 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.