Despite Advantages, Disparities in Access to Palliative Care in Kidney Cancer Remain

Although palliative care has been shown to improve survival rates among patients with metastatic renal cell carcinoma, its utilization remains low while certain barriers and disparities still exist.
BY Alexandra Guadagno
PUBLISHED June 19, 2019
Although palliative care has been shown to improve survival rates among patients with metastatic renal cell carcinoma, its utilization remains low while certain barriers and disparities still exist, according to study results from a study presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting.

“We noticed a significantly better (overall survival) in (metastatic renal cell carcinoma) patients who received (palliative care),” the researchers wrote in their abstract. “Despite the benefits in (overall survival) and guidelines advocating the (palliative care) use, the overall (palliative care) utilization in (metastatic renal cell carcinoma) is markedly low and plagued by race, facility type and geographic region.”

The study considered all patients with metastatic renal cell carcinoma that were reported to National Cancer Database between 2004 to 2015. Patients who died of metastatic renal cell carcinoma were also factored into the study. Researchers classified the patients into three cohorts based on their prognosis and length of survival (less than six months, six to 24 months and over 24 months) to factor in the severity and progression of the cancer.

Using statistical analysis software, researchers performed multivariable logistic regression to determine the patient and institutional factors determining the use of palliative care. 

A total of 29,296 patients were analyzed in the study, of which 20% (5,737 patients) had received palliative care. Of these patients receiving palliative care, 7% received pain management palliative care, 17% received palliative chemotherapy, 7% underwent surgery, 53% received radiation and 12% received combination therapies.

Among patients that survived longer than six months, the patients that received palliative care generally presented with better overall survival, supporting the concept that early integration of palliative care can improve quality of life and survival among patients with cancer. However, it is the disparity in access to that care that poses a problem within the metastatic renal cell carcinoma population.

Patients who received palliative care were more likely to be white and non-Hispanic, treated at non-academic facilities and had higher educational background. Moreover, those who lived in the east, central and mountain regions of the country appeared to be more likely to receive palliative care.

Lastly, the odds of receiving palliative care were significantly higher in patients who survived for longer than six months (23%), compared to those who survived less than 24 months (13%).
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