A. S. Kulaylat1, C. S. Hollenbeak1, D. B. Stewart1 1Penn State Hershey Medical Center,Surgery,Hershey, PA, USA
Introduction: Despite data suggesting decreased cost of care and improved quality of life for patients with terminal cancers, palliative therapy is a frequently under-utilized resource in a variety of malignancies. There is little data on patterns of implementation of palliative therapy in the management of stage IV rectal cancer in the United States.
Methods: Patients diagnosed with rectal adenocarcinoma between 2004 and 2011 were identified within the National Cancer Database (NCDB); those with stage IV disease who did not undergo definitive surgery due to patient or disease-related contraindications comprised the study cohort. Patients undergoing palliative interventions were indicated by a specified variable within the NCDB and were stratified by type of palliation (surgery, radiation, systemic, pain control, a combination thereof, or referral without specified intervention). Multivariable logistic regression was used to identify patient factors associated with receipt of palliative therapy.
Results:A total of 11,245 patients were included in this study, of which 2,314 (20.6%) received palliative therapy. While the rates of patients receiving referrals for palliative therapy (Fig. 1) without a specified intervention did increase significantly (0.1% to 1.5%, p=0.001), the overall utilization of palliative interventions did not change significantly over time (19.4% to 23.0%, p=0.14). During the study period, the use of chemotherapy nearly doubled from 4.7% to 8.7% (p<0.001), while the use of palliative radiation diminished significantly from 7.6% to 5.6% (p=0.001). Patient characteristics associated with the utilization of palliative interventions included patient age greater than 60 years (odds ratios [OR] ranging from 1.17 to 1.35 for age groups over 60, all p<0.02) and increasing chronic comorbidities (OR 1.20, p=0.004 for one comorbidity; OR 1.24, p=0.036 for two or more comorbidities). Differences in gender and race, however, were not associated with receipt of palliative therapy. Patients in the highest income quartile were less likely to undergo palliative interventions (OR 0.84, p=0.018), but insurance status did not have a significant effect on utilization of palliative methods.
Conclusion:For patients with stage IV rectal adenocarcinoma who were managed without curative intent, rates of utilization of palliative therapy were consistently low, with patients who were older and more sickly being more likely to receive palliative care. While insurance and lower socioeconomic status did not appear to limit utilization, identification of barriers to receipt of palliative care requires further study.
