Author(s)
Talia Alonit Wenger, BA
Jaynelle Gao, MS BS
Uttam K. Sinha, MD
Affiliation(s)
Keck School of Medicine of the University of Southern California; Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand that though palliative care has the prospect of improving quality of life for many head and neck cancer patients irrespective of prognosis, only those with the poorest prognosis receive palliative care, and they tend to initiate palliative care less than 6 months prior to death.
Objectives: Head and neck cancer (HNC) patients have high rates of morbidity and mortality, yet few receive palliative care. We aim to characterize the small portion of HNC patients who do receive palliative care.
Study Design: Retrospective cohort.
Methods: Using the TriNetX database and TriNetX Advanced Analytics, cohorts were developed of adults with any HNC diagnosis (ICD-10:C00-C14, C32, C76.0) with or without an encounter with palliative care. Propensity score matching was used to balance groups for age, sex, and cancer stage. Kaplan-Meier survival curves were utilized to create hazard ratios for survival with a 95% confidence interval. Risk ratios were developed with a 95% confidence interval.
Results: The analytic cohort included 24,558 for each group after matching. Patients with HNC and at least one palliative care encounter had a greater than 3 times risk of mortality compared to patients with HNC without palliative care (HR: 3.05, 95% CI: 2.97-3.14). Median survival for patients who received palliative care was 148 compared to 5015 days without. HNC patients who received palliative care had higher risk of depression (HR: 1.38, 95% CI: 1.33-1.45), anxiety (HR: 1.47, 95% Cl: 1.33-1.45), and failure to thrive (HR: 3.26, 95% CI: 3.03-3.51). Patients who received palliative care were nearly five times as likely to discuss end of life care planning (RR: 4.97, 95% CI: 4.39-5.62).
Conclusions: Palliative care can be a powerful tool for HNC patients, yet only the most dire patients receive access. Furthermore, HNC patients tend to initiate palliative care less than 6 months prior to their death, despite having higher levels of depression, anxiety, and failure to thrive.