Older men of lower socioeconomic status less likely to receive specialized palliative care

Older patients, men, and those belonging to lower socioeconomic groups tend to receive less hospital-based specialized palliative care (SPC), reports a recent study. Such a pattern indicates potential under-treatment in these populations.

Researchers conducted a nationwide analysis, enrolling 45,251 cancer patients who had recently been diagnosed and died from 2010–2014. This study sample excluded those who had skin cancer and whose causes of death were deemed to be unrelated to cancer. At death, patients were a median 75 years old, and nearly half (46 percent) were women.

A little under half (43 percent; n=19,404) of study participants received SPC. Most of these were given as inpatient care (38 percent; n=17,375), while 18 percent (n=8,246) were given in outpatient setting. Fourteen percent (n=6,217) of patients received SPC both as inpatient and outpatient care.

Older patients were much less likely to be given SPC. Those who were aged ≥90 years, for instance, were 91 percent less likely to receive such care modality as compared to patients younger than 50 years of age (odds ratio [OR], 0.09, 95 percent confidence interval [CI], 0.08–0.11).

Similarly, men were 15 percent less likely to receive end-of-life SPC than women (OR, 0.85, 95 percent CI, 0.82–0.89). Meanwhile, those with low household income were more than 50 percent less likely to be given SPC than patients with higher income (top vs bottom quartile: OR, 1.55, 95 percent CI, 1.43–1.68).

Cancer clinical characteristics also affected SPC likelihood. Those with metastatic disease (OR, 1.64, 95 percent CI, 1.57–1.72) had better odds of receiving SPC, as were patients with colorectal, pancreatic, kidney, bladder, or gastric tumours.