Socioeconomic Disparity Trends in End-of-Life Care for Cancer and Non-Cancer Patients: Are We Closing the Gap?

Socioeconomic Trends in Palliative Care: A Six-Year Study

The use of palliative care (PC) is on the rise in the USA, with clear benefits to patients, families, hospitals, and insurance companies. Our study investigates trends in PC utilization, focusing on socioeconomic characteristics. The National Inpatient Sample (NIS) from 2015 to 2020 was used to identify adults hospitalized in the United States (US). International Classification of Diseases, Tenth Revision (ICD-10), was used for PC encounters, code Z51.5. An equal number of random records, stratified by year and without this code, were selected to serve as controls. Records were analyzed for baseline characteristics using a chi-square test. Adjusted odds ratios (ORs) of receiving PC were calculated using multivariate logistic regression. Men were more likely to receive PC consults (OR: 1.07, confidence interval (CI): 1.06-1.08). Medicare/Medicaid holders' PC access was limited compared to private insurance holders (0.89, 0.86-0.93). Racial minorities, particularly Hispanics (0.9, 0.86-0.95) and Blacks (0.83, 0.77-0.88), were less likely to engage in PC. Compared to urban teaching hospitals, rural hospitals had a decreased rate of PC utilization (0.53, 0.49-0.57). Smaller hospitals had significantly fewer PC referrals than large hospitals (0.80, 0.76-0.85). A lower socioeconomic status was associated with a reduced propensity to utilize PC services compared to an upper socioeconomic status (0.91, 0.87-0.96). Our analysis shows that socioeconomic factors strongly influence PC access. This highlights important inequities that require measures to improve equitable PC access across demographic groups.

Dimensions of suffering and the need for palliative care: experiences and expectations of patients living with cancer and diabetes and their caregivers in Mexico - a qualitative study

OBJECTIVES

Over 40 million people in low-income and middle-income countries (LMICs) experience serious health-related suffering (SHS) annually and require palliative care. Patient and caregiver experiences of SHS in LMICs are understudied despite their importance in guiding palliative care provision. Diabetes and cancer are the second-leading and third-leading causes of death in Mexico, causing a significant SHS burden on patients, families and health systems. This study examines SHS and palliative care from the point of view of patients with cancer and diabetes and their caregivers.

DESIGN

A qualitative descriptive study based on in-depth telephone interviews was conducted between August 2021 and February 2022. Data were analysed through inductive thematic analysis.

PARTICIPANTS

Overall, 20 patients with end-stage cancer, 13 patients with diabetes and 35 family caregivers were interviewed individually.

SETTING

Participants were recruited from two family medicine clinics and a pain clinic in Mexico City.

RESULTS

Seven themes emerged: (1) suffering as a multifaceted phenomenon, (2) diversity in perceptions of suffering, (3) different coping strategies, (4) need and perceived importance of relief from suffering, (5) barriers to accessing services to relieve suffering, (6) demand for the health sector's active and humane role in addressing suffering and (7) preferences and need for comprehensive care for relief from suffering. The primary coping strategies included family companionship, protective buffering and faith-based support. Participants lacked knowledge of palliative care. They expressed the importance of relief from suffering, viewing it as the health sector's responsibility and requesting more humane, personalised care and access to medicines and pain clinics.

CONCLUSIONS

The multifaceted nature of SHS highlights the health system's responsibility to provide high-quality palliative care. Policies to enhance access to palliative care should integrate it into primary care, redesigning services towards patient and caregiver biopsychosocial and spiritual needs and ensuring access to medicines and competent health personnel.

The use and timing of rehabilitation and palliative care to cancer patients, and the influence of social vulnerability - a population-based study

OBJECTIVES

To identify and investigate different cohorts of cancer patients' use of physical rehabilitation and specialised palliative care (SPC) services, focusing on patients with incurable cancer and the impact of social vulnerability.

METHODS

The sample originated from patients diagnosed during 2013-2018 and alive 1 January 2015. Use of physical rehabilitation and/or SPC units were identified from contacts registered in population-based administrative databases. Competing-risks regression models were applied to investigate disparities with regard to social vulnerability, disease duration, gender and age.

RESULTS

A total of 101 268 patients with cancer were included and 60 125 survived longer than 3 years after their diagnosis. Among the 41 143 patients, who died from cancer, 66%, survived less than 1 year, 23% survived from 1 to 2 years and 11% survived from 2 to 3 years. Contacts regarding physical rehabilitation services appeared in the entire cancer trajectory, whereas contacts regarding SPC showed a steep increase as time drew closer to death. The largest disparity was related to disease duration. Socially vulnerable patients had less contact with SPC, while a larger proportion of the socially vulnerable cancer survivors used rehabilitation, compared with the non-vulnerable patients.

CONCLUSIONS

This study provides a previously unseen detailed overview of the use of physical rehabilitation and/or SPC among patients with incurable cancer. The services appeared to overlap at a group level in the cancer trajectory, emphasising the importance of awareness with regard to coordination and combination of the services. Disparities between socially vulnerable or non-vulnerable patients were identified.