Palliative Care

PV QA 3 - Poster Viewing Q&A 3

TU_29_3029 - Palliative Care Practice Patterns Among Patients with Lung Cancer Metastatic to the Brain.

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Palliative Care Practice Patterns Among Patients with Lung Cancer Metastatic to the Brain.
L. Dover, P. Li, and H. Boggs; University of Alabama at Birmingham, Birmingham, AL

Purpose/Objective(s): This study aims to estimate palliative care utilization rates among lung cancer patients with brain metastases, a population for whom improvements in quality of life with early integration of palliative care have been consistently demonstrated.

Materials/Methods: This analysis measured rates of palliative-directed therapy among patients with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) metastatic to the brain at time of diagnosis from 2010-2014 in the National Cancer Database (NCDB). Palliative-directed therapy is defined in the NCDB as any care with palliative intent including surgical, radiation, medical or pain management interventions. Multivariable logistic regression was used to produce adjusted odds ratios (OR) for factors potentially associated with incorporation of palliative-directed therapy. After propensity score matching, 15,078 patients with and without incorporation of palliative-directed therapy were selected for survival analysis.

Results: A total of 67,634 cases met inclusion criteria (80.1% NSCLC, 51.8% male; median age 65 years). At least one palliative-directed therapy was incorporated into the treatment of 22,766 (33.7%) patients, cancer-directed treatment without incorporation of palliative-directed therapy was received by 38,020 (56.2%) patients, and the remaining 6848 (10.1%) patients received no codified treatment. On multivariate analysis, odds of receiving palliative-directed therapy were lower with non-white or black race (OR 0.84; 95% CI 0.77-0.92), absence of comorbidities (OR 0.93; 95% CI 0.88-0.98), and increasing income in a step-wise fashion (reference <$38K: $38K-<48K OR 0.85, 95% CI 0.80-0.89; $48K-<63K OR 0.81, 95% CI 0.77-0.86; ≥$63K OR 0.76, 95% CI 0.71-0.81). Odds of receiving palliative-directed therapy were higher among those living in more educated areas in a step-wise fashion (area residents without high school diploma, reference ≥20%: 13-20% OR 1.19, 95% CI 1.13-1.25; 7-<13% OR 1.33, 95% CI 1.26-1.41; <7% OR 1.36, 95% CI 1.27-1.46). Among only those receiving some codified treatment (n=60,786), incorporation of any palliative-directed therapy had a similar significant inverse correlation with living in wealthier areas and direct correlation with living in more educated areas, as did receipt of palliative-intent radiation. The median survival in months for patients receiving incorporation of palliative-directed therapy versus cancer-directed therapy only was 4.8 (IQR 4.7-5.0) versus 6.8 (IQR 6.6-7.0), respectively.

Conclusion: A surprising majority of patients receiving cancer-directed treatment for lung cancer metastatic to the brain have no incorporation of palliative-intent care as codified in the NCDB. This was particularly common for patients living in wealthier and/or less educated areas. This poses an important question of how we are framing our treatment recommendations across various populations.

Author Disclosure: L. Dover: None. P. Li: None.

Laura Dover, MD, MSPH

Biography:
Dr. Laura Dover is currently a chief resident physician in the Department of Radiation Oncology at the University of Alabama at Birmingham (UAB). She received undergraduate degrees summa cum laude in both Philosophy and Spanish from the University of Alabama, with semesters spent at both Oxford University in the U.K. and the University of Alcalá in Spain, earning recognition on the USA Today’s All-USA Academic Team. She went on to receive her medical doctorate with AOA distinction from the UAB School of Medicine, during which time she completed an oncology summer fellowship at Johns Hopkins University School of Medicine. She then completed a transitional year internship at Memorial Sloan Kettering Cancer Center before joining UAB's radiation oncology residency program. Her passions within the field of radiation oncology lie in education and policy efforts to ensure quality and accessibility of radiation therapy, and to this end she received a Master of Science of Public Health with a focus on healthcare policy from the UAB School of Public Health during her residency training. Her clinical interests include integration of palliative care into comprehensive cancer care models, which has been the focus of her research endeavors.

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