Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Yale Cancer Center Advanced Training Program for Physician Scientist, NIH T32 Fellowship, Yale University School of Medicine, New Haven, Connecticut, USA.
Cancer Med. 2024 May;13(9):e7028. doi: 10.1002/cam4.7028.
Palliative treatment has been associated with improved quality of life and survival for a wide variety of metastatic cancers. However, it is unclear whether the benefits of palliative treatment are uniformly experienced across the US cancer population. We evaluated patterns and outcomes of palliative treatment based on socioeconomic, sociodemographic and treating facility characteristics.
Patients diagnosed between 2008 and 2019 with Stage IV primary cancer of nine organ sites were analyzed in the National Cancer Database. The association between identified variables, and outcomes concerning the administration of palliative treatment were analyzed with multivariable logistic regression and Cox proportional hazard models.
Overall 238,995 (23.6%) of Stage IV patients received palliative treatment, which increased over time for all cancers (from 20.7% in 2008 to 25.6% in 2019). Palliative treatment utilization differed significantly by region (West less than Northeast, OR: 0.55 [0.54-0.56], p < 0.001) and insurance payer status (uninsured greater than private insurance, OR: 1.35 [1.32-1.39], p < 0.001). Black race and Hispanic ethnicity were also associated with lower rates of palliative treatment compared to White and non-Hispanics respectively (OR for Blacks: 0.91 [0.90-0.93], p < 0.001 and OR for Hispanics: 0.79 [0.77-0.81] p < 0.001).
There are important differences in the utilization of palliative treatment across different populations in the United States. A better understanding of variability in palliative treatment use and outcomes may identify opportunities to improve informed decision making and optimize quality of care at the end-of-life.
姑息治疗已被证明可提高多种转移性癌症患者的生活质量和生存率。然而，姑息治疗的益处是否在美国癌症患者中普遍存在仍不清楚。我们评估了基于社会经济、社会人口学和治疗机构特征的姑息治疗模式和结局。
在国家癌症数据库中分析了 2008 年至 2019 年间诊断为九个器官部位 IV 期原发性癌症的患者。采用多变量逻辑回归和 Cox 比例风险模型分析了确定变量与姑息治疗管理相关的结果之间的关联。
总体而言，238995 例（23.6%）IV 期患者接受了姑息治疗，所有癌症的姑息治疗使用率均呈上升趋势（从 2008 年的 20.7%上升到 2019 年的 25.6%）。姑息治疗的利用情况在不同地区（西部小于东北部，OR：0.55 [0.54-0.56]，p<0.001）和保险支付人状态（无保险大于私人保险，OR：1.35 [1.32-1.39]，p<0.001）之间存在显著差异。与白人或非西班牙裔相比，黑人种族和西班牙裔也与较低的姑息治疗率相关（黑人的 OR：0.91 [0.90-0.93]，p<0.001，西班牙裔的 OR：0.79 [0.77-0.81]，p<0.001）。
在美国不同人群中，姑息治疗的应用存在重要差异。更好地了解姑息治疗使用和结局的变异性可能会为改善知情决策和优化临终关怀质量提供机会。
