Early palliative care among patients diagnosed with advanced cancers in the US (2010-2019): Trends and contribution of provider variation.

11017 Background: Early integration of palliative care (PC) is recommended for advanced cancers, but evidence of its use and the role of provider practice patterns and organizational characteristics in uptake is limited. This study examined recent trends of early PC among Medicare beneficiaries newly diagnosed with advanced cancers, and provider- and organization-variation in the receipt of early PC. Methods: We identified patients aged ≥65.5 years newly diagnosed with advanced stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2010-2019 with ≥6 months survival and continuous fee-for-service coverage from the linked SEER-Medicare data. Early PC was identified by claims with corresponding diagnosis codes or hospice and palliative medicine provider specialty codes within 90 days post-diagnosis or up to first hospice admission date (whichever came earlier). Treating physicians and corresponding organizations (i.e., Tax Identification Number) were assigned based on the plurality of visits within 180 days after diagnosis. We described the percent of patients receiving early PC each year. Generalized linear models with physician- and organization-fixed effects evaluated variation in early PC receipt between and within physicians/organizations. Results: Among 103,045 patients treated by 25,736 unique providers and 11,163 organizations, the percent receiving early PC increased from 0.98% in 2010 to 10.64% in 2019. Although statistically significant increases were observed across cancer types, receipt in patients with prostate cancer was relatively lower compared to pancreas, SCL, NSCL, and breast cancers (Table). After adjusting for patients’ characteristics, variation in early PC use between treating providers and organizations explained 47.9% and 31.2% of the total variation, respectively. Conclusions: Despite considerable growth in early PC receipt, utilization remained low in 2019. The large variation between providers and organizations suggests important modifiable provider behaviors and organizational characteristics in early PC use, which warrant future research. Table: see text