Trends in palliative care interventions among patients with advanced bladder, prostate, or kidney cancer: A retrospective cohort study

Patrick M Lec; Andrew T Lenis; Wayne Brisbane; Vidit Sharma; Vishnukamal Golla; Kiran Gollapudi; Jeremy Blumberg; Alexandra Drakaki; Jonathan Bergman; Karim Chamie

doi:10.1016/j.urolonc.2020.04.029

Trends in palliative care interventions among patients with advanced bladder, prostate, or kidney cancer: A retrospective cohort study

Urol Oncol. 2020 Nov;38(11):854.e1-854.e9. doi: 10.1016/j.urolonc.2020.04.029. Epub 2020 May 17.

Authors

Affiliations

¹ Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address: PLec@mednet.ucla.edu.
² Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA.
³ Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
⁴ Department of Urology, Institute of Urologic Oncology (IUO), David Geffen School of Medicine, University of California, Los Angeles, CA; Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA.
⁵ Los Angeles County Department of Health Services, Los Angeles, CA.

PMID: 32430252
DOI: 10.1016/j.urolonc.2020.04.029

Abstract

Background: Palliative care has an established role in improving the quality of life in patients with advanced cancer, but little is known regarding its delivery among patients with urologic malignancies.

Objective: To determine trends in the utilization of palliative interventions among patients with advanced bladder, prostate, and kidney cancer.

Design, setting, and participants: We performed a retrospective cohort study of patients from years 2004 to 2013 in the National Cancer Database diagnosed with stage IV bladder (n = 17,997), prostate (n = 23,322), and kidney (n = 34,697) cancer, after excluding those with missing disease stage, treatment, and outcomes data.

Outcome measurements and statistical analysis: Descriptive statistics and logistic regression were performed to evaluate utilization of palliative care intervention. Utilization was analyzed by cancer type and by overall survival strata (<6, 6-24, and >24 months). Kaplan-Meier and Cox proportional hazards models analyzed overall survival.

Results and limitations: Palliative interventions were utilized in 12.5% (2,257/17,997), 14.7% (3,442/23,322), and 19.9% (6,935/34,697) of advanced bladder, prostate, and kidney cancer patients, respectively. Older age and longer survival were associated with lower odds of palliative intervention utilization in each malignancy, as was minority race in kidney and bladder cancer patients. Palliative radiation was used most commonly, and utilization of any palliative intervention was associated with poorer overall survival. Limitations largely stem from imperfect data abstraction, and the analysis of interventions' incomplete reflection of palliative care.

Conclusions: Palliative interventions were seldom used among patients with advanced urologic malignancies. Palliative interventions were less frequently used in older patients and minority races. Further study is warranted to define the role of palliative interventions in advanced urologic malignancies and guide their utilization.

Keywords: Bladder cancer; End-of-life care; Kidney cancer; Palliative care; Prostate cancer.

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Humans
Kidney Neoplasms / pathology
Kidney Neoplasms / therapy*
Male
Middle Aged
Neoplasm Staging
Palliative Care / trends*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / therapy*
Retrospective Studies
Urinary Bladder Neoplasms / pathology
Urinary Bladder Neoplasms / therapy*