O. Monton1, A. Gurau1, A. Siddiqi1, K. Kopecky1, J. B. Greer1, F. M. Johnston1 1Johns Hopkins University School Of Medicine, Surgical Oncology, Baltimore, MD, USA
Introduction: Advanced retroperitoneal sarcoma can include unresectable locoregional disease, abdominal sarcomatosis, and distant metastasis, all of which present unique challenges and symptoms for the patient that can be addressed through palliative care. Current trends in the utilization and uptake, and factors associated with palliative care use in patients with retroperitoneal sarcoma remain largely unexplored. The objectives of this study are to (1) describe the national trends in palliative care utilization, and (2) identify factors associated with the use of palliative care in patients with advanced retroperitoneal sarcoma from 2004 to 2020.
Methods: This study is a retrospective cohort study using the National Cancer Database (NCDB). We identified adult patients who were diagnosed with advanced (AJCC stages III and IV) retroperitoneal sarcoma from 2004 to 2020. We performed a trend analysis to describe palliative care utilization over time, followed by univariable and multivariable logistic regression analyses to identify predictors of palliative care use within this time period.
Results: A total of 6,149 patients with advanced retroperitoneal sarcoma were identified, of which only 383 utilized palliative therapies, including palliative surgery (n=28), palliative radiation (n=87), palliative chemotherapy (n=115), pain management (n=61), a combination of these modalities (n=55), and other (n=37). The proportion of patients using palliative care increased significantly from 2.5% in 2004 to 6.1% in 2020 (ptrend<0.001) (Figure 1), with a 5% increase in the odds of palliative care utilization per year (OR 1.05, 95 CI 1.03-1.08). On multivariable logistic regression, age (OR 1.03, 95 CI 1.01-1.04), lack of insurance (OR 2.18, 95 CI 1.17-4.04), community cancer program status (OR 1.83, 95 CI 1.05-3.19), stage IV disease (OR 5.19, 95 CI 4.49-7.79), and rhabdomyosarcoma histology (OR 2.75, 95 CI 1.45-5.95) were found to be predictors of palliative care use.
Conclusion: This study sheds light on the evolving landscape of palliative care use for patients with advanced retroperitoneal sarcoma in the United States from 2004 to 2020. The observed gradual increase in the use of palliative care underscores the growing recognition of its importance in managing the unique challenges associated with this complex disease. Despite this positive trend, the persistently low overall rates highlight the need for further efforts to enhance awareness and accessibility of palliative care for this patient population.
