Racial and ethnic disparities in palliative care utilization among gynecological cancer patients

Gynecol Oncol. 2021 Feb;160(2):469-476. doi: 10.1016/j.ygyno.2020.11.031. Epub 2020 Dec 2.

Abstract

Background: Palliative care (PC) is recommended for gynecological cancer patients to improve survival and quality-of-life. Our objective was to evaluate racial/ethnic disparities in PC utilization among patients with metastatic gynecologic cancer.

Methods: We used data from the 2016 National Cancer Database (NCDB) and included patients between ages 18-90 years with metastatic (stage III-IV) gynecologic cancers including, ovarian, cervical and uterine cancer who were deceased at last contact or follow-up (n = 124,729). PC was defined by NCDB as non-curative treatment, and could include surgery, radiation, chemotherapy, and pain management or any combination. We used multivariable logistic regression to evaluate racial disparities in PC use.

Results: The study population was primarily NH-White (74%), ovarian cancer patients (74%), insured by Medicare (47%) or privately insured (36%), and had a Charlson-Deyo score of zero (77%). Over one-third of patients were treated at a comprehensive community cancer program. Overall, 7% of metastatic gynecologic deceased cancer patients based on last follow-up utilized palliative care: more specifically, 5% of ovarian, 11% of cervical, and 12% of uterine metastatic cancer patients. Palliative care utilization increased over time starting at 4% in 2004 to as high as 13% in 2015, although palliative care use decreased to 7% in 2016. Among metastatic ovarian cancer patients, NH-Black (aOR:0.87, 95% CI:0.78-0.97) and Hispanic patients (aOR:0.77, 95% CI:0.66-0.91) were less likely to utilize PC when compared to NH-White patients. Similarly, Hispanic cervical cancer patients were less likely (aOR:0.75, 95% CI:0.63-0.88) to utilize PC when compared to NH-White patients.

Conclusions: PC is highly underutilized among metastatic gynecological cancer patients. Racial disparities exist in palliative care utilization among patients with metastatic gynecological cancer.

Keywords: Cervical cancer; Gynecologic cancers; National Cancer Data Base; Ovarian cancer; Palliative care; Racial disparities; Uterine cancer.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Black or African American / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Genital Neoplasms, Female / diagnosis
  • Genital Neoplasms, Female / mortality
  • Genital Neoplasms, Female / pathology
  • Genital Neoplasms, Female / therapy*
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Medicare / statistics & numerical data
  • Middle Aged
  • Neoplasm Staging
  • Palliative Care / statistics & numerical data*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • United States / epidemiology
  • White People / statistics & numerical data
  • Young Adult