ASO Author Reflections: How Does Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surger
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: How Does Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surgery? Alizeh Abbas, MD, and Timothy M. Pawlik, MD, MPH, MTS, PhD Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
PAST
PRESENT
Despite multiple efforts to encourage the integration of palliative care into a patient’s surgical treatment plan, utilization of hospice care among patients undergoing cancer surgery remains low.1–3 In addition, there is mounting evidence that disparities exist in the receipt of end-of-life care relative to sex, race/ethnicity, and insurance status.4 Social Determinants of Health (SODH), described as factors associated with an individual’s environment and community of residence, have been associated with access to healthcare and outcomes.5,6 The Social Vulnerability Index (SVI) has been developed as a composite SODH metric.7 Given that there are limited data on the impact of social vulnerability relative to overall hospice utilization especially among minority patients, we sought to examine the association between patient race/ethnicity and county-level vulnerability on the patterns of hospice utilization.8
A total 54,256 Medicare beneficiaries underwent lung (n = 16,645, 30.7%), esophageal (n = 1427, 2.6%), pancreatic (n = 6183, 11.4%), colon (n = 26,827, 49.4%), or rectal (n = 3174, 5.9%) cancer resection between 2013 and 2017. Median patient age was 76 years (interquartile range [IQR] 71–82), and 28,887 individuals (53.2%) were male. The majority of individuals were White (91.1%, n = 49,443), whereas a smaller subset was Black or Latino (racial/ethnic minority: n = 4813, 8.9%). Overall, 35,416 (65.3%) patients utilized hospice services before death. Among patients who utilized hospice, median time to initiation of hospice services was 372 (IQR 149–707) days after surgery. Patients came from counties that had a median SVI of 52.8 (IQR 30.3–71.2). There was no difference in the median SVI among nonhospice users (53.3, IQR 30.3–71.2) versus hospice utilizers (52.2, IQR 30.3–70.8). On multivariable analysis, older patients (10year increase: odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08–1.13) and individuals with more preoperative comorbidities (OR 1.05, 95% CI 1.04–1.06) were more likely to use hospice after surgical resection of a cancer (both p \ 0.05). Of note, even after controlling for age, comorbidity status, and cancer diagnosis, White patients were still much more likely to have utilized hospice care after surgical resection of a cancer (OR 1.24, 95% CI 1.17–1.31, p \ 0.001). Unlike White patients, there was reduced odds of hospice utilization (OR 0.97, 95% CI 0.96–0.99) and early hospice initiation (OR 0.94, 95% CI 0.91–0.97) as SVI increased among minority patients.
ASO Author Reflections is a brief invited commentary on the article, ‘‘Race/ethnicity and county l
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