Abstract
1. Understand and apply the implications of palliative care underutilization in patients with metastatic SCLC.
Small cell lung cancer (SCLC) commonly involves metastasis to the bone, brain, liver, and/or lung by the time of initial diagnosis. Due to the resulting high symptom burden, integration of palliative care (PC) has the potential to improve quality of life and impact overall survival (OS).
Investigate how PC therapies are utilized and the resulting OS of patients with metastatic SCLC.
Patients diagnosed with SCLC (ICD-O-3 histology code 8041/3) between 2004-2019 were identified in the National Cancer Database (N=305,082). Associations between metastasis and PC utilization were evaluated using Pearson's chi-squared analysis with Bonferroni adjustment. OS was analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling.
The majority of patients did not receive any PC (83.7%), though PC utilization has steadily increased from 2004 (4.0%) to 2019 (7.8%) despite the incidence of SCLC remaining stable across this period (ranging from 5.5% to 6.5%). Of those who did receive PC, most received either radiation (33.1%) or systemic therapy (35.0%). Most of the cohort had stage IV disease (50.2%). Of the patients with available metastasis data (N=81,573), those with metastasis to the bone (24.3%), brain (17.6%), liver (31.1%), and lung (11.2%) at initial diagnosis were more likely to receive PC, particularly radiation or systemic therapy (p<0.05). Meanwhile, those without metastasis were less likely to receive any PC (p<0.05). Kaplan-Meier and Cox regression demonstrated that OS was worse in patients who received any form of PC than those who did not: no PC (21.31 months, HR=1 [reference]), surgery (9.43 months, HR=1.491), radiation (11.83 months, HR=1.584), systemic therapy (11.93 months, HR=1.262), pain management (5.07 months, HR=2.408).
Despite research discussing the benefits of PC integration with oncology, it remains underutilized in patients with metastatic SCLC. Additional studies should analyze the factors hindering incorporation of PC into this population.