Knowledge of Palliative Care in Men and Women Diagnosed With Metastatic Breast Cancer

While in recent years, both treatment choices and outcomes have improved for men and women diagnosed with metastatic breast cancer (mBC) this population of cancer patients is often faced with the need for lifelong treatment of their disease. Quality of life can be impacted by both the disease and the treatment. Supportive care, known as palliative care, is needed to help those patients with mBC optimize their quality of life; however palliative care is underutilized. Access and availability to this care may be related to a patient's social determinants of health (SDOH).

Social determinants of health such as accessibility to services, the lack of patient health literacy, and community and social factors, in addition to distrust in medical care and gaps in medical knowledge, may all prevent the effective dissemination of palliative care. The purpose of this study was to consider the impact of systemic and patient-related factors including SDOH, socioeconomics, race, and ethnicity, on the use of palliative care in a diverse population of men and women diagnosed with metastatic breast cancer.

This study took place at a Cancer Center affiliated with an academic medical center in New Jersey. Inclusion criteria included all patients diagnosed with mBC, age 18 and older. A telephone-administered survey was provided to 101 patients receiving treatment at a Cancer Center in an urban area of the Northeast US. The survey, which took about 15 minutes to complete, was primarily researcher-developed and included questions on demographics, SDOH, Palliative Care, and communication preferences. Additional survey questions were drawn from the Edmonton Symptom Assessment Scale (ESAS), a validated instrument that is commonly used for symptom screening and monitoring in ambulatory oncology and palliative care.

All respondents were insured. Of the 101 participants, only 22 (21.78%) indicated receiving palliative care services. Participants who reported being followed by palliative care were less likely to have been treated in the emergency department in the past year (p= 0.003) or to have been hospitalized (p=0.042). However, when asked about symptom burden, using the Edmonton Symptom Assessment Scale, patients who reported being followed by PC were more likely to report severe pain as compared to patients not receiving PC (p<0.001). No associations were found between race/ethnicity and PC. There were no associations found between social determinants of health and knowledge of PC or receipt of services.

This sample of men and women diagnosed with metastatic breast cancer had limited knowledge and exposure to palliative care services across race and ethnicity. While no specific disparity was noted, the utilization of palliative care was low. Whether a function of a lack of referrals or patient preference, an effort should be made to increase palliative care referrals for all patients diagnosed with cancer. For those patients diagnosed with metastatic cancer, palliative care services should be introduced into the care plan early to change the cultural perception that palliative care is end-of-life care.