Yadav Sandhya, Turner Kea, Xie Zhigang, Chen Guanming, Islam Jessica Y, Suk Ryan, Hong Young-Rock
Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
Palliat Support Care. 2024 Oct;22(5):1027-1034. doi: 10.1017/S1478951523000354.
Palliative care can improve the quality of life of adolescents and young adults (AYA) with cancer. However, little is known about the utilization of palliative care among AYA cancer patients. Identifying factors associated with the utilization of palliative care could inform efforts to improve palliative care access among AYA patients living with cancer.
Using data from the National Inpatient Sample 2016-2019, a representative sample of US hospitalizations, we examined palliative care encounters and associated characteristics among hospitalizations of AYA with cancer and high inpatient mortality risk. Survey design-adjusted bivariate and multivariable logistic regression models were used to examine associations of patient- and hospital-level characteristics with palliative care.
Of 10,979 hospitalizations by AYA cancer patients with high mortality risk, 19.9% received palliative care services between 2016 and 2019. After adjusting for all characteristics, independent predictors of palliative care use were as follows: older age (25-39 years old vs. 25-39 years; odds ratio [OR] 1.31, 95% confidence interval [CI] 1.15-1.49), Hispanic/Latinx (vs. non-Hispanic White; OR 1.16, 95% CI 1.01-1.34), female (vs. male; OR 1.27, 95% CI 1.14-1.41), public insurance (vs. private insurance; OR 1.23, 95% CI 1.10-1.38), hospital location in the US South (vs. Northeast; OR 0.78, 95% CI 0.66-0.94), and a large hospital (vs. small; OR 0.83, 95% CI 0.72-0.96).
Less than 20% of AYAs with cancer and high risk of mortality received inpatient palliative care services. Further research is needed to explore the reasons for lower palliative care utilization in the younger age groups.
姑息治疗可提高青少年及年轻成人（AYA）癌症患者的生活质量。然而，对于AYA癌症患者姑息治疗的使用情况知之甚少。确定与姑息治疗使用相关的因素可为改善癌症AYA患者获得姑息治疗的努力提供信息。
利用2016 - 2019年全国住院患者样本（美国住院治疗的代表性样本）的数据，我们研究了AYA癌症患者住院期间的姑息治疗情况及相关特征，这些患者具有高住院死亡率风险。采用调查设计调整后的双变量和多变量逻辑回归模型来研究患者和医院层面特征与姑息治疗的关联。
在10979例具有高死亡风险的AYA癌症患者住院病例中，2016年至2019年间有19.9%接受了姑息治疗服务。在对所有特征进行调整后，姑息治疗使用的独立预测因素如下：年龄较大（25 - 39岁与15 - 24岁相比；比值比[OR] 1.31，95%置信区间[CI] 1.15 - 1.49）、西班牙裔/拉丁裔（与非西班牙裔白人相比；OR 1.16，95% CI 1.01 - 1.34）、女性（与男性相比；OR 1.27，9% CI 1.14 - 1.41）、公共保险（与私人保险相比；OR 1.23，95% CI 1.10 - 1.38）、医院位于美国南部（与东北部相比；OR 0.78，95% CI 0.66 - 0.94）以及大型医院（与小型医院相比；OR 0.83，95% CI 0.72 - 0.96）。
不到20%的具有高死亡风险的AYA癌症患者接受了住院姑息治疗服务。需要进一步研究以探索较年轻年龄组姑息治疗利用率较低的原因。
