Palliative care utilization among head and neck cancer patients: A population-based analysis

Head and neck cancer (HNC) patients face substantial morbidity and mortality. Despite the potential benefits of palliative care (PC) in improving quality of life, many HNC patients do not receive these services. This study aimed to quantify the proportion of HNC patients receiving PC, the timing of PC referrals, and the mental health and clinical outcomes of this population.

A retrospective cohort study was conducted using the TriNetX database with de-identified electronic medical records. HNC patients were categorized based on whether they had at least one PC encounter. We examined time to first PC encounter, mortality rates, mental health diagnoses, and access to ACP and supportive care.

Of 304,404 HNC patients, only 22,470 (7.4 %) had at least one PC encounter. The median time from cancer diagnosis to initial PC referral was 318 days. After propensity score matching, the cohorts consisted of 24,916 patients each. Those who received PC had a significantly higher risk of mortality (RR 3.05, 95 % CI 2.97-3.14), depression (RR 1.38, 95 % CI 1.33-1.45), anxiety (RR 1.47, 95 % CI 1.42-1.53), failure to thrive (RR 3.26, 95 % CI 3.03-3.51), and were more likely to engage in advance care planning (RR 4.97, 95 % CI 4.39-5.62) and access supportive care services compared to patients who did not receive PC.

PC utilization among HNC patients is low, with patients often waiting nearly a year before their first PC encounter. This delay highlights a significant unmet need for early integrated PC in this population.