Racial Disparities in Palliative Care Use Found Among Patients with Ovarian and Cervical Cancer

According to a study published in Data in Brief, disparities in palliative care use exist among patients with metastatic gynecological cancers, suggesting there is unequal treatment among these patients according to race/ethnicity.

If utilized correctly, the research team suggests these data can help inform the continued practice of health care providers who recommend treatment options for patients with gynecological cancers.

“Demonstrating that racial disparities in palliative care utilization among [patients with gynecologic cancers] exist may encourage health care providers to re-examine their treatment recommendations and improve equitable receipt of high-quality cancer care in the United States,” wrote the investigators who were led by Jessica Y. Islam PhD, MPH.

The main analysis found that 5% of all patients with gynecologic cancers in the population utilized palliative care. By cancer site, use of palliative care was reported in 4% of patients with ovarian cancer, 9% with cervical cancer, and 11% with uterine cancer. Of the patients who used palliative care in some form, 62% utilized only surgery, radiation, or chemotherapy while 12% utilized pain management.

When looking at patients with ovarian cancer specifically, the research team found that Hispanic patients were less likely to use palliative care compared to non-Hispanic White patients (adjusted odds ratios [aOR]: 0.79, 95% CI: 0.68–0.91).

For patients with cervical cancer, the data found that Hispanic (adjusted odds ratio [aOR], 0.65; 95% CI, 0.56-0.75) and Asian patients (aOR, 0.74; 95% CI, 0.59-0.93) were less likely to use palliative care than non-Hispanic White patients with the same disease.

The team did not observe racial disparities as it relates to palliative care use among patients with uterine cancer.

More, when examining patients who were still alive at last follow-up, only 3% of the population utilized palliative care. While the team was able to conduct multivariable analyses of disparities for ovarian and cervical cancer, the limited sample size of patients with uterine cancer who were alive at last follow-up rendered it impossible to do the same for this group.

Looking at this population of patients with various metastatic gynecologic cancers via the multivariable analyses, the team concluded that no racial/ethnic disparities exist.

“Our results can be used as rationale to develop and implement interventions to improve equitable provision of palliative care among [patients with gynecologic cancer] in the United States,” explained the investigative team.

The investigators conducted an analysis of 176,899 patients with metastatic gynecologic cancers, both alive and dead, as well as a separate examination of the 66,781 patients alive at last follow-up. The team collected data from the 2016 National Cancer Database (NCDB). The mean age of the population was 66 years (range, 18-90).

The primary end point of the data was palliative care use as defined by the NCDB among patients with metastatic gynecologic cancer. The research team explained that the NCDB “codes treatments as palliative only if the patient’s medical records explicitly mentioned that the goal of treatment is palliation and not cure.”

Reference:

Islam JY, Deveaux A, Previs RA, et al. Racial disparities in palliative care utilization among metastatic gynecological cancer patients living at last follow-up: an analysis of the National Cancer Data Base. Data Brief. 2020;34:106705. doi:10.1016/j.dib.2020.106705