緩和ケアと医学

抽象的な

Factors Contributing to Palliative Care Use in Pancreatic Cancer: A Review of the 2004 - 2016 National Cancer Database

Gabriela L. Aitken, Patrick T. Reynolds, Christopher J. Gannon, Omar H. Llaguna

Introduction: Palliative Care (PC) is offered to patients with pancreatic cancer with the aim of providing symptomatic relief and enhancing quality of life. Despite its benefits, utilization varies. The purpose of this study was to determine factors associated with PC use amongst patients who died of pancreatic cancer.

Methods: Deceased patients treated for pancreatic adenocarcinoma were identified using the 2004-2016 National Cancer Database. Multivariable logistic regression was used to evaluate patient, disease, and institutional features associated with PC use. Patients were classified into three categories based on survival: <6 months, 6-12 months, and 12+ months.

Results: A total of 296,617 patients were identified, of which 14.7% received PC. Patient characteristics with the largest percentages included: white (83.8%), Charlson-Deyo score of 0 (65.1%), Medicare (59.3%), metropolitan location with population >1 million (50.5%), stage IV cancer (45.2%), East Coast (43.3%), and treatment in an academic/research program (40.9%). Patients with stage II, III, and IV cancer had increased odds of receiving PC in all survival groups compared to stages 0 and I. The percentage of patients receiving PC was significantly greater in those surviving 12 months (17.0% vs. 9.7%, respectively). Multivariable logistic regression revealed that patients who received PC were more likely to be younger, Asian, Medicaid, recently diagnosed, have stage IIIV disease, not have a high school diploma, have a higher Charlson-Deyo score, report a median annual income <$38,000, and live in urban or rural areas.

Conclusions: Amongst patients diagnosed with pancreatic cancer, there is a national underutilization of PC with <15% of patients engaging in these services. Disparities are known to exist in both access to and provision of PC services. Identifying patterns associated with PC use is the first step towards closing this gap in health equity, as these factors can be used to create interventions aimed at increasing patient participation in these adjuncts.