Access to palliative care services within patient-sharing networks for patients with breast, colorectal and non-small...

Timely delivery of palliative care (PC) services improves outcomes for patients with cancer; however, utilisation remains low. This study aimed to determine access to PC clinicians for patients with early and advanced-stage cancer and assess collaboration with oncology physicians using patient-sharing networks.

Using Surveillance, Epidemiology, and End Results-Medicare data (2016-2019), we identified patients with stage I-IV breast, colorectal or non-small cell lung cancer. PC encounters within 12 months after diagnosis were included. PC clinicians were defined as those with at least one PC encounter and further categorised as formally trained PC specialists or non-specialists (billing code only). Patient-sharing networks evaluated the extent of collaboration between oncology physicians and PC specialists. Direct connections were defined as physicians sharing patients with a PC specialist; indirect connections as sharing patients with another clinician who was directly connected to a PC specialist.

Among 100 891 patients, 6% received PC services, with higher rates observed for stage IV disease (15%) compared with stages I-III (3%). Only 33% of PC encounters were delivered by PC specialists (36% in stages I-III; 32% in stage IV). In 2019, 85% of medical oncologists had either a direct (16%) or indirect (69%) connection with a specialist.

Patient-sharing network analysis revealed limited integration of specialty PC, with most oncologists indirectly collaborating with PC specialists. Expanding the specialist workforce and strengthening collaboration are essential to improve access and quality of PC delivery.