Bridging the gap: Palliative care outcomes in academic versus community centers for advanced non-small cell lung cancer patients.

Abstract

e23081 Background: The impact of care at academic versus community centers for palliative management of non-small cell lung cancer (NSCLC) remains underexplored. Methods: We conducted a retrospective analysis using the National Cancer Database (NCBD) and included patients with NSCLC, diagnosed from 2012 to 2016. Patients receiving treatment with curative intent or those receiving care at both academic and community centers, were excluded. Survival outcomes were assessed through Kaplan-Meier survival analyses. Multivariate regression analysis was performed using accelerated failure time model (AFT) for estimation of covariate adjusted hazard ratios (HR). Statistically significant variables from the AFT model were further analyzed using multivariate logistic regression to assess their relative representation in academic versus community centers. Results: The study included 14,693patients, with 11,620 (79.5%) treated at Academic Centers, and 3,019 (20.5%) treated at Community Centers. Of these, 8,623 (58.9%) were aged ≥65 years, 11,547 (78.88%) were White, 8,015 (54.74%) were male, and 8,165 (55.75%) had Medicare insurance. Patients receiving care in academic centers had a mOS of 5.72 months (HR0.87 ([0.91 - 0.83, p < 0.01]), compared to 4.76 months for patients receiving care at community hospitals (p < 0.05). Multivariate regression analysis revealed that Black and Asian patients had significantly lower hazard ratios (HRs), while patients with oligometastatic disease and a Charlson-Deyo Score (CDWS) of 1 had higher HRs. Black patients had HR of 0.88 (95% CI [0.84–0.93], p < 0.01), while Asian patients had HR of 0.68 (95% CI [0.61–0.75], p < 0.01) compared to White patients. CDWS of 1 was associated with HR of 1.12 (95% CI [1.08–1.17], p < 0.01) compared to CDS of 0. Similarly, patients with oligometastatic disease (M1a) had a HR of 1.37 (95% CI [1.28–1.46], p < 0.01). Subgroup analysis revealed findings that correlated with findings from the AFT, indicating that patients treated at academic centers were more likely to be Black (vs. White; OR 2.90, 95% CI [2.49–3.39], p < 0.01), Asian (vs. White; OR 1.73, 95% CI [1.32–2.25], p < 0.01), with CDS scores of 1 (OR 0.85, 95% CI [0.77–0.94], p < 0.01) and M1a cases compared to M0 had lower odds (OR 0.81, 95% CI [0.69–0.95], p < 0.01). Conclusions: Academic centers appear to offer better care in advanced NSCLC. While some of this difference is explained by covariates, further quality-of-care initiatives are needed to bridge these gaps and ensure equitable care delivery across all treatment centers.