Trends and disparities in palliative care utilization in advanced head and neck cancer hospitalizations.

Abstract

12058 Background: Greater than 60% of Head and neck cancer (HNC) patients have advanced cancer at the time of presentation. They have unique physical and psychological symptoms due to the cancer’s anatomical location and multimodal treatment-related toxicities. 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 advanced HNC patients in the US. Methods: A retrospective longitudinal study was conducted using the NIS database (2008-2021). Using joinpoint regression and multivariable logistic regression, trends and factors associated with PC receipt were assessed. Results: The overall prevalence of palliative care utilization among 326,265 hospitalizations with advanced HNC was 11%. Over the period, palliative care utilizations increased from 3,651 to 16,982 per 100,000 advanced HNC admissions (p-trend <0.001) with an average annual percentage increase of 9.7%. Females with metastatic HNC had higher odds (Adjusted odds ratio (AOR): 1.11; 95% CI: 1.04-1.19) of receiving palliative care compared to males. There was similar likelihood of utilizing palliative care across racial groups. Patients in teaching hospitals had 46% higher likelihood (AOR: 1.46; 95% CI: 1.33-1.60) of palliative care use in comparison to patients in non-teaching hospitals. Large hospitals had higher palliative care use compared to small hospitals (AOR: 1.12; 95% CI: 1.01-1.25). Admissions in the south and west had higher likelihood of palliative care use relative to those in the North-east region. Patients covered by Medicaid had higher odds of palliative care receipt compared to those covered by Medicare. Relative to patients who had a routine discharge home or with self-care, those discharged to facilities or with home health care were four-fold more likely (AOR: 4.35; 95% CI: 3.98-4.75) to receive palliative care. Those who died during hospitalization were also more likely to use palliative care (AOR: 21.4; 95% CI: 19.1-24.0). Non-elective admissions had higher likelihood of palliative care receipt relative to elective visits. Conclusions: Although palliative care utilization has improved over the years, it remains suboptimal. Tailored interventions addressing sociodemographic and hospital-level disparities will promote equitable access and meet the unique needs of this patient population. Predictors of PC use. Variables AOR (95% CI) Age “60 years and above“ vs “Less than 60” 1.0 (0.93-1.07) Gender Female vs Male 1.11 (1.04-1.19) Race Non-Hispanic Black vs Non-Hispanic White 1.02 (0.93-1.13) Hispanic vs Non-Hispanic White 1.10 (0.97-1.25) Non-Hispanic Others vs Non-Hispanic White 0.92 (0.82-1.03) Hospital region Midwest vs Northeast 1.09 (0.97-1.23) South vs Northeast 1.23 (1.10-1.37) West vs Northeast 1.37 (1.22-1.55) Hospital Teaching Status Teaching vs Nonteaching 1.46 (1.33-1.60)