Trends and Predictors of Palliative Therapy Use in Young Adults with Advanced Gastrointestinal Cancer: A National...

Young adults (YAs) with advanced gastrointestinal (GI) cancer have unique care needs, which may be addressed through palliative therapy.

The aims of this study were to describe temporal trends and identify predictors of palliative therapy utilization in YAs with advanced GI cancer.

We conducted a retrospective cohort study using the National Cancer Database. YAs (18-39 years of age) diagnosed with advanced GI cancer from 2004 to 2020 were identified. We performed a trend analysis followed by univariable and multivariable logistic regression analyses.

A total of 43,616 YAs with advanced GI cancer were identified, of whom 3820 (8.76%) were treated with palliative therapy. The proportion of patients who received palliative therapy increased significantly, from 5.33% in 2004 to 12.36% in 2020 (p^trend< 0.05). Patients of non-White/non-Black race (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.09-1.40), with no insurance (OR 1.35, 95% CI 1.20-1.53), and with a median income of less than $63,000 (OR 1.20, 95% CI 1.08-1.34) were more likely to receive palliative therapy. Multiple comorbidities (OR 1.59, 95% CI 1.24-2.06), stage IV disease (OR 8.28, 95% CI 7.33-9.34), and cancers of the esophagus (OR 2.26, 95% CI 1.88-2.71), liver (OR 2.19, 95% CI 1.88-2.56), pancreas (OR 2.20, 95% CI 1.53-3.16), and biliary tract (OR 2.12, 95% CI 1.54-2.91) were also predictors of palliative therapy utilization.

Palliative therapy utilization in YAs with advanced GI cancer increased significantly over the study period, however major gaps remain in the provision of this care. Further work is needed to understand the barriers to access among YAs.