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PQA 04 - PQA 04 Palliative Care and Central Nervous System Poster Q&A

2527 - Impact of Race/Ethnicity on Inpatient vs. Outpatient Access to Palliative RT

Monday, September 30, 2024
10:45 AM – 12:00 PM ET
Location: Hall C

Screen: 33

A. K. Heng1, T. Gooley2, S. S. Lo3, J. T. Yang4, E. F. Gillespie4, L. M. Halasz3, and Y. D. Tseng3; 1University of Washington School of Medicine, Seattle, WA, 2Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, WA, 3Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA, 4Department of Radiation Oncology, University of Washington, Seattle, WA

Purpose/Objective(s): Though palliative radiation (pRT) is an important component in the management of cancer patients, little is known whether there is equitable access to pRT. We evaluated whether there are differences among pRT patients seen as an inpatient versus outpatient and predictors for inpatient status, specifically from the lens of race/ethnicity. Materials/

Methods: This retrospective, single-institution study included cancer patients =18 years that were consecutively treated for pRT 10/2021-10/2022. Any hospitalization or additional RT within 3 months from pRT were recorded. To evaluate whether there were differences in pRT patient management, a subset of outpatients that received pRT for painful lesions was analyzed for medications prescribed at consult, time to pRT start from consult, and fractions prescribed. Associations between race/ethnicity with inpatient consult were evaluated using logistic regression models.
Results: 548 pRT courses from 439 patients were analyzed. Patients were older (median, 63 years), predominantly male (56.2%), White non-Hispanic (WNH, 72.6%), English-speaking (92.9%) and married/partnered (65.5%). 19% (104 courses) were consulted as inpatients. Demonstrable differences were seen among inpatients versus outpatients with respect to race/ethnicity, primary language, insurance, histology, and RT indication (all p <.01) but not distance to RT clinic, Charlson Comorbidity Index, age and sex. In a univariate analysis, race/ethnicity (global p <.01) was associated with inpatient consult, in which Black/African Americans (BAA), compared to WNH, had 3.90 times higher odds of being seen as an inpatient (95% CI 1.90-8.02, p<.01). After adjusting for histology and primary language, race/ethnicity remained significantly associated with inpatient consult, with BAA patients having 3.36 times higher odds compared to WNH patients (Table 1). Among 290 outpatients treated for painful lesions, there was no difference (all p>.05) in RT fractions (median 5), prescribed pain medications or days to pRT start (median 9) by race/ethnicity. There was no difference by race/ethnicity (all p>.05) in hospitalizations or additional RT within 3 months after pRT.
Conclusion: Within this single-institution experience, there was differential access to pRT with disproportionate BAA patients seen as inpatients, even after adjusting for histology. Within the limitations of crude metrics, pRT care delivered appears similar across race/ethnicity. Future research is needed to understand what factors may contribute to disparate access to pRT care. Table 1. Multivariate Analysis
Variable Group OR LCL UCL p-value Global p </span>
Race White Non Hispanic 1 --- --- --- 0.010
Asian 0.82 0.36 1.89 0.64
Black/African American 3.36 1.61 7.03 0.001
Other 1.04 0.44 2.48 0.93
White Hispanic 2.06 0.73 5.83 0.17
Histology Solid 1 --- --- ---
Hematologic 1.89 1.08 3.29 0.025
Language Non-English 2.32 0.99 5.42 0.052