TOPLINE

Despite guideline recommendations for concurrent palliative care, fewer than 1 in 5 young adults with advanced cancer received palliative care alongside systemic cancer treatment during 2021-2023. Although palliative care use increased from 9.3% in 2010 to 18.3% in 2023, uptake varied substantially across cancer types.

METHODOLOGY

• Palliative care is recommended for all patients diagnosed with advanced cancers alongside cancer-directed systemic treatments, but patterns of palliative care uptake are not well-known among young adults.
• In a retrospective cohort study, researchers analyzed data from patients aged 18-39 years diagnosed between 2010 and 2023, using the National Cancer Database, which captures approximately 72% of cancer cases in the US.
• A total of 67,706 patients were included (median age 33 years): 62,072 were diagnosed with stage IV solid tumors and 5634 were diagnosed with poor-prognosis high-grade brain tumors.
• Palliative care was defined as any care to alleviate symptoms, including palliative-intent therapy focusing on surgery, radiation therapy, or systemic therapy as well as care focusing on pain management and nonprocedural supportive care.
• Researchers compared patients who received concurrent palliative care alongside cancer-directed systemic therapy with those who received cancer-directed systemic therapy alone during the first course of treatment.

TAKEAWAY

• During 2021-2023, only 17.1% of young adults with advanced cancers received palliative care concurrently with cancer-directed systemic therapy, with utilization increasing from 9.3% in 2010 to 18.3% in 2023.
• Concurrent palliative care receipt was highest for patients with lung cancer (39.1%), gastric cancer (32.6%), kidney cancer (29.9%), female breast cancer (28.2%), and pancreatic cancer (27.6%).
• Prevalence was lowest for Hodgkin lymphoma (1.9%), non-Hodgkin lymphoma (4.1%), poor-prognosis brain tumors (4.3%), and head and neck cancers (4.4%).
• Compared with patients receiving systemic therapy alone, those who received concurrent palliative care were more likely to be aged 35-39 years, female, Medicaid-insured, and treated at community cancer programs (P < .001).

IN PRACTICE

“As the incidence of early-onset cancers continues to increase among young adults, targeted policies and resources are needed to ensure that concurrent [palliative care] is accessible for this population,” the study authors concluded.

SOURCE

The study, led by Kewei Sylvia Shi, MPH, American Cancer Society, Atlanta, was published online in a research letter on July 23 in JAMA Network Open.

LIMITATIONS

The study lacks information in the National Cancer Database to distinguish specialty palliative care from nonprocedural care such as advanced care planning, psychosocial care, or spiritual care. Palliative care is captured only during first-course treatment, potentially underestimating later use. The authors noted that the findings should be interpreted as palliative care captured by registry rather than comprehensive specialty palliative care. The study excluded patients who survived less than 30 days, which may have introduced selection bias by excluding those with the most aggressive disease courses.

DISCLOSURES

Sylvia Shi disclosed receiving a fellowship from PhRMA Foundation outside the submitted work. Xin Hu disclosed receiving grants from National Institutes of Health, American Cancer Society, Patrick and Catherine Weldon Donaghue Medical Research Foundation, Pfizer, Johnson & Johnson, and PhRMA Foundation outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.