Disparities in Palliative Care Utilization in Metastatic Triple-negative Breast Cancer: A National Cancer Database...

Metastatic triple-negative breast cancer (TNBC) is characterized by an aggressive clinical course and poor prognosis relative to other breast cancer subtypes. Real-world palliative care (PC) utilization patterns in this population remains poorly characterized. This study examined the sociodemographic, policy, and facility-level factors associated with PC utilization in metastatic TNBC.

Adults with metastatic TNBC (2018-2023) were identified from the National Cancer Database. PC was defined as non-curative intent surgery, radiation, systemic therapy, pain management, or any combination. Multivariable logistic regression evaluated sociodemographic and facility-level factors associated with PC utilization.

Among 9,211 patients with metastatic TNBC, 1,798 (19.5%) received PC. The most common modalities were systemic therapy (42.9%), multimodal combinations (24.5%), and radiation (22.8%). Medicaid-expansion states were associated with higher PC utilization [adjusted odds ratios (aORs)=1.39-1.83 across expansion timing categories; all p<0.05]. Uninsured patients had higher odds of PC utilization than privately insured patients [aOR=1.53, 95% confidence interval (CI)=1.14-2.07; p=0.005]. Treatment at academic/research programs was associated with higher PC utilization than community cancer centers (aOR=1.31, 95%CI=1.01-1.71; p=0.041). Geographic variation was observed, with higher odds of PC utilization in the Northeast, South, and Midwest than the West (all p<0.05).

In this largest population-level study to date, we found that PC utilization remains low among patients with metastatic TNBC, and was associated with insurance coverage, facility type, and geographic region. These findings highlight disparities in access to PC and underscore the need for more equitable and timely integration of PC among patients with metastatic TNBC.