Abstract
1. Analyze the population demographics of SRCC in order to understand palliative care integration in SRCC patients.
2. Evaluate the potential role and effect of palliative care in SRCC.
Signet ring cell carcinoma (SRCC) is a rare adenocarcinoma subtype with late presentation and poor prognosis. Therefore, these patients may particularly benefit from palliative care (PC).
Evaluate PC utilization among patients with SRCC of the most common and fatal sites.
The National Cancer Database (2004-2019) was queried for patients diagnosed with SRCC (ICD-O-3 histology code 8490/3) of the colon (N=15,251), esophagus (N=4,786), and stomach (N=37,361). Socioeconomic factors contributing to disparities in PC utilization and overall survival (OS) were analyzed.
Besides colonic SRCC (48.4% male), the cohort was predominantly male (85.6% esophagus, 52.6% stomach) and mostly treated at academic/research facilities (42.7% esophagus, 38.9% stomach). PC utilization has been stable, but low, from 2004 (4.1% colon, 3.5% esophagus, 4.0% stomach) to 2019 (6.5%, 2.3%, 6.3%). Patients treated at academic/research facilities (31.3% colon, 36.1% esophagus, 38.7% stomach) especially in West South Central states were more likely to receive PC (p<0.05). Patients with stage IV disease were more likely to receive PC (53.5% colon, 58.9% esophagus, 59.7% stomach) than those with stage I (1.3%, 2.2%, 2.9%). Patients with Medicare (49.9% colon, 50.5% esophagus, 43.8% stomach) were less likely to receive PC for colonic and esophageal SRCC. Those with private insurance (37.4% colon, 34.3% esophagus, 36.6% stomach) were less likely to receive any PC for esophageal or gastric SRCC but more likely to receive systemic palliative therapy for colonic SRCC. Those receiving palliative radiotherapy had worse OS (7.048 months for colon, 8.307 esophagus, 9.828 stomach) than those not receiving any PC (56.358, 35.953, 45.036). After adjusting for other variables, OS for esophageal SRCC remained significant (HR=1.826).
PC remains broadly underutilized in SRCC, especially among nonacademic facilities (particularly the Pacific region) and patients without private insurance. Future studies should evaluate how PC can be better incorporated in this population.