Palliative care usage fluctuates with income, insurance coverage
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NEW ORLEANS —Patients treated in integrated cancer centers had higher use of palliative care but overall use remained low, according to a presentation at ASH Annual Meeting and Exposition. Privately insured individuals also showed low utilization.
“Several studies have shown that palliative care improves survival in diverse malignancies and should be incorporated in the care of patients with malignancies,” said Faith Abodunrin, MD, a third-year internal medicine resident at Creighton University School of Medicine in a presentation. “Our study aimed to describe socioeconomic trends in the utilization of palliative care in patients with diffuse large B-cell lymphoma.”
The study included 264,549 patients with diffuse large B cell lymphoma who were identified by variables that affected access to palliative care including age, sex, race, facility type, Charlson-Deyo comorbidity score, median household income, educational status, insurance status and year of diagnosis.
Of individuals included, 3.2% utilized palliative care. Integrated cancer centers more likely provided palliative care than community care programs (OR = 1.17; 95% CI, 1.05-1.32) and patients from households with a median income of greater than $63,333 were less likely to receive palliative care than those from low-income (< $40,227) households (OR = 0.77; 95% CI, 0.7-0.85). Privately insured patients less likely received palliative care (OR 0.7; 95% , 0.59-0.83) and were the lowest utilization group among all insurance groups.
“We found an unexpectedly low utilization of palliative care among patients who are privately insured and in those with higher incomes. A possible explanation for this finding might be that palliative care measures are not covered by private insurance. It is also possible that patients who are affluential and those with private insurance are more likely to pursue novel treatments, aggressive treatments rather than palliative care,” Abodunrin said. “Alternatively, these patients might be more likely to be offered further chemotherapy by their oncologists rather than palliative care. These postulates should be further studied at different institutions and could potentially serve as a guide for health care policy.”
Palliative care utilization increased significantly from 2004-2007 to 2016-2019 (2.6% vs. 3.71%; P < 0.001). Hispanic patients were less likely than white patients to receive palliative care (OR = 0.74; 95% CI, 0.65-0.83), but a significantly statistic difference was not found between white patients and other non-Hispanic patients.
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Abodunrin F, et al. Poster 4898. Presented at: ASH Annual Meeting and Exposition; Dec. 10-13, 2022; New Orleans.
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