112 Background: Early, concurrent palliative care (PC) improves quality of life for patients with cancer. Shortages of formally trained PC providers is a barrier to care and can lead to PC delivery by non-specialists. Patterns of PC use across disease stages and provider types remain understudied. We examined PC use by cancer stage (I-III vs. IV), identified provider types, and assessed collaboration between PC specialists and non-specialists. Methods: We used SEER-Medicare data (2016-19) to identify patients aged 66-99 with breast, colorectal, or lung cancer. PC was defined using billing codes or provider taxonomy. Providers with at least one PC encounter were classified as PC providers, further categorized into formally trained PC specialists (taxonomy-PC) and non-specialists (PC billing code only). PC use by patient and provider characteristics was examined with bivariate analyses. We analyzed patient-sharing provider networks to assess whether non-specialist PC providers were collaborating with formally trained PC specialists. Results: Among 101,321 patients, 5.5% received PC (14.5% with stage IV vs. 2.8% with stage I-III cancers), with low use across all cancer types: lung (15.7% vs. 5.9%), colorectal (12.5% vs. 3.0%) and breast (10.4% vs. 1.0%). Use of PC increased over time and was more often received at NCI-Designated Cancer Centers. Among stage I-III, patients who received PC (vs. those who did not) were more likely to be aged ≥ 80 years (39.7% vs. 29.2%) and have ≥ 2 comorbidities (51.6% vs. 35.8%). Among stage IV, patients who received PC (vs. those who did not) were more likely to live in urban (85.9% vs. 81.9%) and high socioeconomic status (29.5% vs. 24.4%) areas. No significant sex or race/ethnicity differences were found. Non-specialist providers delivered most PC encounters, 60% in Stage I–III and 55% in Stage IV. PC providers were mainly Primary Care Providers (PCPs), accounting for 55.5%, followed by formally trained PC specialists (33.0%), medical oncologists (5.2%) and hospitalists (3.5%). Patient-sharing networks showed limited but growing collaboration between non-specialist PC providers and formally trained PC specialists (1.7% in 2016 to 11.3% in 2018). Conclusions: PC is low overall but has grown over time, particularly in late-stage cancer. In stage I-III, PC use reflected individual needs and comorbidities; in stage IV, rural/urban and socioeconomic differences were observed. PCPs often delivered PC and most did not share patients with a formally trained PC specialist. This suggests that PCPs are filling gaps in access where PC specialists are limited. To address unmet needs, efforts should focus on expanding specialty PC capacity, strengthening collaboration between generalists and specialists, and investing in provider training. These strategies are critical for improving access to PC across cancer stages and clinical settings.
Zhang et al. (Wed,) studied this question.