Utilization pattern and service settings of palliative care for patients with metastatic non–small cell lung cancer
An article review, MSPC Fellowship Journal ClubShivani Martin, MD Sep 19, 2023
Background: Although the benefits of palliative care for patients with cancer have been well established, the current utilization pattern remains largely unknown. The authors investigated the temporal trends and service settings of palliative care among Medicare beneficiaries with newly diagnosed, metastatic non–small cell lung cancer (NSCLC).1
Design and Participants: 69,414 patients with NSCLC were identified between January 1, 2001, and December 31, 2013 from the Surveillance, Epidemiology, and End Results-Medicare–linked database. This study included patients aged ≥65 years with newly diagnosed, metastatic NSCLC from January 1, 2001, through December 31, 2013. They excluded patients whose cancer diagnosis was not pathologically confirmed or was based on a death certificate or autopsy. Patients who had another cancer either before or after the diagnosis of NSCLC were also excluded. In addition, individuals who did not have full coverage of both Medicare Parts A and B, or who were enrolled in health maintenance organizations, for 12 months before and 12 months after the cancer diagnosis because their claims were incomplete were also excluded.
Temporal trends in palliative care use and the temporal shift in palliative care service settings were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for the receipt of palliative care, controlling for patients' sociodemographic and clinical characteristics.1
Results: Fifteen percent (10,359) of patients with NSCLC received palliative care within 1 year of a diagnosis of metastatic NSCLC. The proportion of beneficiaries receiving palliative care increased from 3.6% in 2001 to 31.9% in 2013 (P for trend <.001). Multivariable analyses demonstrated that receipt of palliative care varied significantly by sex, race, and region. Most patients (53.5%) had their first receipt of palliative care in a hospital. Less than one-third of patients (27.6%) received palliative care in an outpatient setting or received palliative care in more than 1 service setting (26.3%) in 2013.
Commentary: The number of patients with metastatic NSCLC receiving palliative care has increased substantially. However, there are limitations to this study. First, the Medicare claims database does not contain the medical claims for patients aged <65 years who are ineligible for the Medicare program therefore the findings cannot be generalized to younger, non-Medicare patients with cancer. Second, because not all comprehensive palliative care services are reimbursed by Medicare, overall palliative care received by Medicare beneficiaries may be underestimated. The analysis was performed on patients who received palliative care only within 1 year of cancer diagnosis so the study findings should not be generalized to patients with NSCLC who receive palliative care after 1 year from their cancer diagnosis. Also, the study did not examine differences in palliative care delivery by medical specialty. Future studies should examine trends in which providers are delivering palliative care.
Bottom Line: Although the hospital-based program is still the main form of palliative care delivery, more patients with metastatic NSCLC in recent years have received palliative care services in multiple locations.
Huo J, Hong YR, Turner K, Bian J, Grewal R, Wilkie DJ. Utilization pattern and service settings of palliative care for patients with metastatic non–small cell lung cancer. Cancer. 2019;125(24):4481-4489. doi:10.1002/cncr.32478