Trends and comparisons of palliative care utilization for patients with metastatic gynecologic malignancy.

Objective: To assess the use of non-curative interventions and palliative pain management for patients with advanced gynecologic malignancy in the United States.

Methods: This retrospective cohort study queried the Commission-on-Cancer's National Cancer Database. The study population was 2,098,291 patients with stage IV malignancies from 2004 to 2020, including 5 gynecologic malignancies (uterine cervix, uterine corpus, tubo-ovary, vulva, and vagina) and 7 non-gynecologic malignancies (lung, pancreas, colorectum, breast, kidney, liver, and bladder), stratified by gender. Utilization rates and temporal trends of non-curative interventions (systemic therapy, surgery, radiotherapy) and palliative pain management in the first course of intervention were evaluated across the malignancy types.

Results: In 19 gender-stratified malignancy groups, the median rate of non-curative interventions and palliative pain management use rate was 18.3%. All the gynecologic malignancies ranked below the median, including the 3 lowest groups (12.6%, 10.5%, and 7.8% for uterine corpus, vulva, and tubo-ovary, respectively). Non-curative interventions and palliative pain management use increased significantly in non-gynecologic malignancies, whereas utilization remained unchanged over several years for most gynecologic malignancies, including uterine cervix (19.8% to 20.1% for 2012-2020, p-trend = .744), uterine corpus (12.0% to 13.4% for 2013-2020, p-trend = .072), and tubo-ovary (8.3% to 9.2% for 2011-2020, p-trend = .311). Compared with non-gynecologic malignancies, patients with gynecologic malignancy were less likely to receive non-curative systemic therapy by 48% to 80% (all 5 types), non-curative surgery by 15% to 61% (all but vagina), non-curative radiotherapy by 37% to 95% (uterus, tubo-ovary, vulva), and palliative pain management by 18% to 45% (all 5 types) (all, adjusted-p < .05).

Conclusions: In this cohort study, the initial utilization of non-curative interventions and palliative pain management has been unchanged for patients with advanced gynecologic malignancy, and fewer patients receive palliative care than those with non-gynecologic malignancy, including palliative pain management. Possible under-utilization of palliative care services for patients with advanced gynecologic malignancy call for attention and further investigation.