Purpose
This study addresses a gap in knowledge regarding palliative care utilization patterns in smallcell carcinoma of the prostate.
Background
Prostate cancer is the most common cancer affecting males. One of the most aggressive malignancies of the prostate is small cell carcinoma (SCC) of the prostate. Almost 70% of patients diagnosed with SCC present with the disseminated disease with a low 5-year survival rate of less than 2%. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course. Despite evidence favoring palliative care for prostate cancer in several patient populations, it remains under-utilized. Palliative care utilization patterns in SCC of the prostate have not yet been studied.
Methods
This is a retrospective study of patients diagnosed with all subtypes of AJCC staged metastatic SCC of the prostate between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 615). Exclusion criteria included missing data.
Data Analysis
Variables were evaluated for significance (P < .05) in relation to the receipt of palliative care using Pearson Chi-Square, ANOVA, and Kaplan- Meier tests. Multivariate analysis was performed via binary logistics regression.
Results
Among the 961 patients diagnosed with SCC of the prostate, 64% had metastatic disease (n = 615). The metastatic cohort was more likely to receive palliative care than those that did not have distant metastasis (24.2% vs 5.7%, P < .001). Palliative care use has grown between 2004 (n = 6) and 2017 (n = 20). Patients that were uninsured were more likely than insured patients to receive palliative care (50% vs 23.5%, P = .003; 95% CI, 0.051- 0.546). Non-Hispanic patients were also more likely than Hispanic patients to receive palliative care (P = .033; 95% CI, 1.154-28.140). New England locations had the highest utilization of palliative care (43.%, P = .009). Factors that impacted palliative care use included facility region, insurance status, and Hispanic status. As palliative care continues to be utilized more frequently, we hope that this study can provide a starting point in studying and preventing palliative treatment disparities.