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Factors Affecting Use of Outpatient Specialty Palliative Care Clinics Among Patients With Advanced Cancer

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Key Points

  • Outpatient specialty palliative care was used by only 5% of patients.
  • Colocation of oncologist and palliative care clinics and shorter travel time to clinics were associated with greater likelihood of using palliative care services.

In a study reported in the Journal of Oncology Practice, Yu et al identified factors affecting use of outpatient specialty palliative care (OSPC) among patients with advanced cancer in the University of Pittsburgh Medical Center Hillman Cancer Center Network (UPMC-HCCN).

Study Details

The retrospective cohort study involved 9,485 patients with advanced solid tumors receiving treatment between January 1 and December 31, 2016, within the comprehensive cancer care network, which includes well-established oncology-specific OSPC clinics. The primary outcome measure was use of OSPCs, defined as having made ≥ 1 visit to one of the three clinics in 2016, with a primary focus on the effect of clinic colocation and geographic access on OSPC use.

Factors in OSPC Use

Among the 9,485 patients, 478 (5.0%) received OSPC services in 2016. In multivariate analysis controlling for age, sex, marital status, cancer type, insurance, treatment intent, and illness severity, patients with oncologist practices that were colocated with OSPC clinics were significantly more likely to use OSPC (odds ratio [OR] = 19.2, 95% confidence interval [CI] = 14.1–26.2). Compared with patients with travel times of > 90 minutes to an OSPC clinic, those with travel times of ≤ 30 minutes (OR = 3.2, 95% CI = 2.2–4.6) or 31 to 60 minutes (OR = 2.4, 95% CI = 1.6–3.6) were significantly more likely to use OSPC.

Other factors significantly associated with OSPC use on multivariate analysis included patient age, insurance type, cancer type, treatment intent, and oncologist assessment of life expectancy. For example, odds of using OSPC were 60% higher among patients with noncurative or palliative treatment intent (P = .001) and 70% higher among those whose oncologists “would not be surprised” by their death within 12 months (P < .001). Compared with patients with lung cancer, patients with gynecologic cancer (OR = 1.9, 95% CI = 1.2–2.9) and gastrointestinal cancer (OR = 1.6, 95% CI = 1.1–2.1) were more likely to use OSPC.

The investigators concluded, “Among patients with advanced solid tumors, colocation of oncology and OSPC clinics and shorter patient travel time were associated with greater odds of using OSPC. Future efforts to increase OSPC use in this population should consider clinic colocation and travel burden.”

The study was supported by grants from the National Institute of Child Health and Human Development, American Cancer Society, and National Cancer Institute.

Justin A. Yu, MD, of the Section of Palliative Care and Medical Ethics, University of Pittsburgh, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: See the study authors’ full disclosures at jop.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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