Trends and disparities in palliative care utilization among patients with anal cancer: A ten-year retrospective study.

Abstract

2 Background: Anal cancer patients often experience high symptom burden and psychosocial distress. Early integration of palliative care (PC) in their management can improve health-related quality of life. We examined the trends and predictors of PC utilization among hospitalized anal cancer patients in the US. Methods: A retrospective longitudinal study using the NIS database (2010-2019) was conducted. Using joinpoint regression and multivariable logistic regression, trends and factors associated with PC receipt were assessed. Results: The overall prevalence of PC utilization in the cohort of about 70,000 admissions with anal cancer was 6.9%. PC consultations increased from 3,372 to 11,081 per 100,000 anal cancer hospitalization (p-trend <0.001) with an average annual percentage change of 12.8%. Individuals ≥ 60 years with anal cancer had lower odds (Adjusted odds ratio (AOR): 0.81; 95% CI: 0.68-0.97) of receiving PC compared to their counterparts < 60 years. Patients in the second (AOR: 1.31; 95% CI: 1.05-1.62), and fourth (AOR: 1.29; 95% CI: 1.01–1.64) median household national income quartiles had about 30% greater likelihood of utilizing PC relative to those in the first income quartile. Patients in teaching hospitals had 40% higher likelihood (AOR: 1.40; 95% CI: 1.14-1.71) of PC in comparison to patients in non-teaching hospitals. Relative to patients who had a routine discharge home or with self-care, those discharged to facilities or with home health care were five-fold more likely (AOR: 5.04; 95% CI: 4.09-6.20) to receive PC. Those who died during hospitalization were also more likely to utilize PC (AOR: 33.9; 95% CI: 24.9-46.1). Other factors associated with PC receipt were non-elective admissions and higher Comorbidity burden. Conclusions: Though the trends in PC utilization have improved over the years, it remains suboptimal. Older patients were less likely to receive PC. Targeted interventions are needed to narrow the identified disparities for optimal utilization of PC in this patient population. Factors predicting the use of palliative care among hospitalized anal cancer patients. a Unadjusted Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI) Age “60 years and above “vs “Less than 60” 0.98 (0.86-1.12) 0.81 (0.68-0.97) Hospital region South vs Northeast 1.04 (0.84-1.29) 1.33 (1.04-1.69) West vs Northeast 1.28 (1.02-1.61) 1.39 (1.06-1.82) Hospital Teaching Status Teaching vs Nonteaching 1.36 (1.16-1.60) 1.40 (1.14-1.71) Patient disposition Transfer to facility/home health care vs Routine discharge 4.98 (4.14-5.99) 5.04 (4.09-6.20) Died vs Routine discharge 39.4 (30.2-51.4) 33.9 (24.9-46.1) Admission type Non-elective vs Elective 2.97 (2.39-3.68) 2.91 (2.28-3.70) Median Household income national quartiles Quartile 2 vs Quartile 1 1.07 (0.90-1.29) 1.31 (1.05-1.62) Quartile 4 vs Quartile 1 1.17 (0.96-1.42) 1.29 (1.01-1.64) a CI = confidence intervals.