Factors associated with receipt of palliative-only care among survivors with head and neck cancer.

Abstract

73 Background: Head and neck cancer (HNC) survivors with end-stage disease may receive multimodal treatment with non-curative intent. However, besides clinical indications for palliative care, there is a paucity of data describing nonclinical factors associated with receipt of palliative care. This study aimed at characterizing sociodemographic factors associated with HNC survivors receiving palliative-only care. Methods: We used data from the National Cancer Database from 2004-2014, restricting our cohort to adult HNC survivors receiving palliative-only care. Multivariate logistic regression estimated association between sociodemographic factors and receiving palliative-only care. Survival of palliative-only patients was assessed via Cox proportional hazards model. Final regression models were adjusted for clinical/nonclinical covariates, including: age, comorbidity score, tumor site, cancer stage, histology, HPV status, and population density/urbanization. Results: Out of 325,489 HNC survivors, 2,404 received palliative-only treatment. Mean age was 69.1 years, and median survival was 4.9 months. Sociodemographic factors associated with receiving palliative-only care were gender: (female aOR=1.11; 95% CI 1.02, 1.22), race/ethnicity: [(Hispanic aOR=0.77; 95% CI 0.62, 0.97), (Non-Hispanic Black aOR=1.35; 95% CI 1.20, 1.52)], insurance status: [(uninsured aOR=2.59; 95% CI 2.13, 3.14), (Medicaid aOR=3.11; 95% CI 2.67, 3.61), (Medicare aOR=1.71; 95% CI 1.50, 1.95)], travel distance for care: (≥50 miles aOR=0.64; 95% CI 0.55, 0.74). Additionally, survivors receiving palliative-only care who were uninsured (aHR=1.34; 95% CI 1.08, 1.65), under Medicaid (aHR=1.29; 95%CI 1.10, 1.52), or Medicare (aHR=1.16; 95%CI 1.01, 1.33) were significantly more likely to die compared with those privately insured. Conclusions: Females, blacks, and those uninsured, under Medicaid/Medicare disproportionately contribute to the palliative-only population among HNC survivors. Disparities persist even at end-stage disease among HNC survivors and impact disease outcome.