12073 Background: The 2016 ASCO guidelines recommend that patients with advanced cancer receive dedicated palliative care (PalC) services early in the disease course, concurrent with active treatment, within 8 weeks of diagnosis. Despite these efforts, disparities persist in the use of PalC across various demographic groups. Our study evaluated the pattern and temporal trends in PalC use among adult cancer patients to identify inequities across various clinical factors. Methods: We analyzed adult cancer hospitalizations from the 2016-2022 National Inpatient Sample. PalC was identified using ICD-10 code Z51.5. Utilization trends were examined by hospital type, demographics (age, sex, race/ethnicity), income quartile, and insurance type. Trends in mean age and in-hospital mortality among PalC recipients were calculated. Survey-weighted regression models assessed temporal trends, accounting for complex sampling design (p < 0.05 significant). Results: We analyzed 18,574,934 hospitalizations from 2016 to 2022. PalC utilization increased significantly from 10.61% in 2016 to 14.01% in 2022 (p < 0.001), representing a 32% relative increase. The mean age of PalC recipients rose from 68.61 years to 69.63 years (p < 0.001), while in-hospital mortality remained stable at approximately 28-29% (p = 0.144). Utilization increased across all subgroups (all p < 0.001). By hospital type, urban teaching hospitals had the highest overall utilization (12.40%, range 10.72-14.01%), followed by urban nonteaching hospitals (12.07%, range 10.81-14.63%), and rural hospitals had the lowest (10.77%, range 8.81-12.71%). Black patients had the highest overall utilization (13.44%, range 11.75-15.20%), followed by White (12.15%, range 10.52-14.02%) and Hispanic patients (11.57%, range 10.04-12.48%). Females had higher utilization than males (12.72% vs 11.83%). By insurance, Medicaid had 12.79% utilization (range 11.18-14.60%), Medicare 12.72% (range 11.00-14.52%), and private insurance 10.13% (range 8.86-11.56%). The lowest income quartile had 12.47% utilization (range 10.73-14.31%) compared to 12.04% (range 10.45-13.50%) in the highest quartile. All demographic and socioeconomic subgroups demonstrated significant increasing trends over the study period. Conclusions: PalC utilization increased significantly across all groups, with stable mortality rates. However, disparities remain, with lower utilization in rural hospitals, among privately insured patients, and among Hispanic populations. Despite progress in overall adoption, these findings highlight ongoing inequities in PalC access that require targeted interventions to achieve equitable guideline implementation.
Ramesh et al. (Wed,) studied this question.
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