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Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

Author

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  • Jessica Y. Islam

    (Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
    Cancer Epidemiology Program, Center for Immunization and Infection Research in Cancer (CIIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
    Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA)

  • Veeral Saraiya

    (Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC 27514, USA)

  • Rebecca A. Previs

    (Division of Gynecological Oncology, Duke Cancer Institute, Durham, NC 27710, USA)

  • Tomi Akinyemiju

    (Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA)

Abstract

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.

Suggested Citation

  • Jessica Y. Islam & Veeral Saraiya & Rebecca A. Previs & Tomi Akinyemiju, 2021. "Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States," IJERPH, MDPI, vol. 18(11), pages 1-15, June.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:11:p:6040-:d:568629
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    References listed on IDEAS

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    1. Soobader, M.-J. & LeClere, F.B. & Hadden, W. & Maury, B., 2001. "Using aggregate geographic data to proxy individual socioeconomic status: Does size matter?," American Journal of Public Health, American Public Health Association, vol. 91(4), pages 632-636.
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