Palliative Care in Patients with Advanced NSCLC Varies Among Racial/Ethnic Groups and Insurance Providers

Web Exclusives —March 15, 2023


Lung Cancer

Non–small-cell lung cancer (NSCLC) is typically detected at an advanced stage, giving patients a high symptom burden and a poor 5-year survival rate of 5%. Pain, aching and burning sensations, and neuropathic symptoms are frequently reported in patients who have had surgery. Cough, dyspnea, hemoptysis, and wheezing are experienced by up to 85% of patients. Symptoms like these affect patient quality of life and have an association with shorter survival times. Palliative care can address these symptoms by alleviating symptom burden, improving quality of life, and increasing patient survival time and can lead to greater patient and caregiver satisfaction.

The National Comprehensive Cancer Network recommends that palliative care begin at diagnosis, but barriers to uptake exist. Often palliative care is erroneously associated with poorer prognosis. In addition, racial inequalities in receiving palliative care are encountered in the United States. To characterize racial and ethnic inequalities in palliative care use in patients with advanced NSCLC in the United States, Islam and colleagues used data from the 2004-2016 National Cancer Data Base to examine these inequalities and the role of healthcare access in palliative care.

Data from 803,618 adults aged 18 to 90 years with advanced NSCLC (stage III or IV at diagnosis) were included in the study. The mean patient age was 68 years, 76% of patients were White, 11% were Black, 3% were Hispanic, 2% were Asian, and 55% were men. The study primary outcome was palliative treatment or treatments with noncurative intent to prolong a patient’s life by controlling symptoms, alleviating pain, or providing patient comfort. These measures included pain management, systemic treatment to control symptoms, surgery, and/or radiation. Healthcare access data were also evaluated, which included insurance type, distance from provider or hospital, and type of cancer treatment facility.

Palliative care was used by 19% of patients, with the majority of these patients using chemotherapy, surgery, or radiation alone. Pain management as palliative care was used by 6% of patients. Evaluation of palliative care by race/ethnicity found that Hispanic/Latinx patients had the lowest use at 16%, whereas Native Hawaiian/Pacific Islanders had the highest use at 27%. Patients who were uninsured or Medicaid insured utilized palliative care most commonly at 22% each. Patients with stage IV cancer utilized palliative care at a rate of 26% compared with 6% of patients with stage III cancer. An increase in use of palliative care was seen over time from 16% in 2004 to 21% in 2016. Overall, Black patients and Hispanic/Latinx patients had 9% and 20% lower relative odds, respectively, of using palliative care compared with White patients, whereas Native Americans/Alaska Natives and Native Hawaiians/Pacific Islanders had higher odds compared with White patients.

Source: Islam JY, Braithwaite D, Zhang D, Guo Y, Tailor TD, Akinyemiju T. Racial and ethnic inequities of palliative care use among advanced non-small cell lung cancer patients in the US. Cancer Med. 2022 Dec 19. Epub ahead of print.

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Last modified: August 10, 2023

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