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Rural–urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.

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Title: Rural–urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.
Authors: Freeman, Jincong Q.1,2,3 jjfreem@uchicago.edu, Scott, Adam W.4, Akhiwu, Ted O.5
Source: Journal of Rural Health. Sep2024, Vol. 40 Issue 4, p602-609. 8p.
Subject Terms: Palliative treatment, Research funding, Breast tumors, Logistic regression analysis, Descriptive statistics, Multivariate analysis, Metastasis, Odds ratio, Rural conditions, Metropolitan areas, Health equity, Cancer patient psychology, Confidence intervals
Geographic Terms: Illinois, United States
Abstract: Purpose: To assess trends and rural–urban disparities in palliative care utilization among patients with metastatic breast cancer. Methods: We analyzed data from the 2004–2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as "yes/no." Rural–urban residence, defined by the US Department of Agriculture Economic Research Service's Rural–Urban Continuum Codes, was categorized as "rural/urban/metropolitan." Multivariable logistic regression was used to examine rural–urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. Findings: Of 133,500 patients (mean age 62.4 [SD = 14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004–2005 to 24.5% in 2008–2019 (7.0% increase per year; p‐value for trend <0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (p < 0.001). After covariate adjustment, patients residing in rural (AOR = 0.84; 95% CI: 0.73–0.98) or metropolitan (AOR = 0.85, 95% CI: 0.80–0.89) areas had lower odds of having used palliative care than those in urban areas. Conclusions: In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural–urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Rural Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Rural–urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Freeman%2C+Jincong+Q%2E%22&quot;&gt;Freeman, Jincong Q.&lt;/searchLink&gt;&lt;relatesTo&gt;1,2,3&lt;/relatesTo&gt;&lt;i&gt; jjfreem@uchicago.edu&lt;/i&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Scott%2C+Adam+W%2E%22&quot;&gt;Scott, Adam W.&lt;/searchLink&gt;&lt;relatesTo&gt;4&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Akhiwu%2C+Ted+O%2E%22&quot;&gt;Akhiwu, Ted O.&lt;/searchLink&gt;&lt;relatesTo&gt;5&lt;/relatesTo&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Journal+of+Rural+Health%22&quot;&gt;Journal of Rural Health&lt;/searchLink&gt;. Sep2024, Vol. 40 Issue 4, p602-609. 8p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Palliative+treatment%22&quot;&gt;Palliative treatment&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Research+funding%22&quot;&gt;Research funding&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Breast+tumors%22&quot;&gt;Breast tumors&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Logistic+regression+analysis%22&quot;&gt;Logistic regression analysis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Descriptive+statistics%22&quot;&gt;Descriptive statistics&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Multivariate+analysis%22&quot;&gt;Multivariate analysis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Metastasis%22&quot;&gt;Metastasis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Odds+ratio%22&quot;&gt;Odds ratio&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Rural+conditions%22&quot;&gt;Rural conditions&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Metropolitan+areas%22&quot;&gt;Metropolitan areas&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Health+equity%22&quot;&gt;Health equity&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cancer+patient+psychology%22&quot;&gt;Cancer patient psychology&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Confidence+intervals%22&quot;&gt;Confidence intervals&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Illinois%22&quot;&gt;Illinois&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22United+States%22&quot;&gt;United States&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: To assess trends and rural–urban disparities in palliative care utilization among patients with metastatic breast cancer. Methods: We analyzed data from the 2004–2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as &quot;yes/no.&quot; Rural–urban residence, defined by the US Department of Agriculture Economic Research Service&#39;s Rural–Urban Continuum Codes, was categorized as &quot;rural/urban/metropolitan.&quot; Multivariable logistic regression was used to examine rural–urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. Findings: Of 133,500 patients (mean age 62.4 [SD = 14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004–2005 to 24.5% in 2008–2019 (7.0% increase per year; p‐value for trend &lt;0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (p &lt; 0.001). After covariate adjustment, patients residing in rural (AOR = 0.84; 95% CI: 0.73–0.98) or metropolitan (AOR = 0.85, 95% CI: 0.80–0.89) areas had lower odds of having used palliative care than those in urban areas. Conclusions: In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural–urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Journal of Rural Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/jrh.12826
    Languages:
      – Code: eng
        Text: English
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      Pagination:
        PageCount: 8
        StartPage: 602
    Subjects:
      – SubjectFull: Palliative treatment
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Breast tumors
        Type: general
      – SubjectFull: Logistic regression analysis
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Multivariate analysis
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      – SubjectFull: Metastasis
        Type: general
      – SubjectFull: Odds ratio
        Type: general
      – SubjectFull: Rural conditions
        Type: general
      – SubjectFull: Metropolitan areas
        Type: general
      – SubjectFull: Health equity
        Type: general
      – SubjectFull: Cancer patient psychology
        Type: general
      – SubjectFull: Confidence intervals
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      – SubjectFull: Illinois
        Type: general
      – SubjectFull: United States
        Type: general
    Titles:
      – TitleFull: Rural–urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer.
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            NameFull: Scott, Adam W.
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              M: 09
              Text: Sep2024
              Type: published
              Y: 2024
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