Abstract
1. Identify population trends in palliative care utilization within PASC.
2. Understand the impact of palliative care utilization on overall survival in PASC.
Pancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreatic cancer characterized by an unknown squamous histology with overall poor survival. Given its aggressive nature and poor prognosis, these patients may benefit from palliative care.
Analyze trends in PC utilization among patients with PASC.
The National Cancer Database (2004-2019) was queried to identify patients diagnosed with PASC (ICD-O-3 histology code 8560/3). Chi-squared test analyzed disparities in palliative care utilization. Kaplan-Meier, log rank test, and multivariate Cox proportional hazards analyses were used to study the effect of palliative care usage on overall survival.
Of the cohort studied (N=3,121), patients were predominantly male (53.7%) and mostly treated at academic/research facilities (49.3%). The majority of patients were covered by Medicare (59.1%) followed by private insurance (30.3%). Palliative care utilization has increased from 2004 (10.8%) to 2019 (17.1%), but nonetheless remains low. Patients with stage IV disease were more likely to receive palliative care (23.6%) than those with stage I (6.3%) or stage II (6.1%). Overall survival in those who received palliative care (10.95 months) was worse compared to not receiving any palliative care (24.82 months). After adjusting for other variables, overall survival was significantly impacted by facility type, facility location, insurance status, and comorbidities. Decreased risk for death was associated with being treated at an academic/research facility (HR=0.614), being in the Atlantic region (HR=0.814), and having private insurance (HR=0.617). Increasing comorbidities was associated with greater survival outcomes (HR=1.151).
Although previous studies have examined the outcomes of PASC, none has specifically looked at palliative care trends in the disease. Palliative care remains underutilized in PASC and is impacted by socioeconomic factors; thus, future studies should evaluate how PC can be better utilized to improve patient care and quality of life.