Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center: determinants of use and barriers to access.
Abstract   Background: Cancer causes significant symptom burden and diminished quality of life. Despite the expansion of supportive and palliative care services (SPCS), little is known about rates of utilization and barriers to access to these services among oncology outpatients.


METHODS
We performed a cross-sectional survey in three outpatient medical oncology clinics. Patients with a diagnosis of breast, lung, or gastrointestinal (GI) cancer and a Karnofsky score of ≥60 were included. Patients reported their use of SPCS and any perceived barriers. Multivariable logistic regression was used to identify factors associated with SPCS use.


RESULTS
Among 313 participants, (50.5%) had not used SPCS since cancer diagnosis. The most common services used were nutrition (26.5%), psychiatric/psychological counseling (29.7%), and physical therapy (15.1%). Pain/palliative care and cancer rehabilitation consultations were used by 8.5% and 4.1% of participants, respectively. In multivariate analysis, graduate education was associated with greater SPCS use (adjusted odds ratio [AOR] 2.14, 95% confidence interval [CI] 1.08-4.26) compared with those with high school or less, whereas having lung cancer was associated with less SPCS use (AOR 0.48, 95% CI 0.24-0.96) when compared with those having breast cancer. The biggest reported barriers to using SPCS were a lack of awareness (22.4%) and lack of physician referral (23%).


CONCLUSIONS
Approximately half of these patients had not accessed SPCS since cancer diagnosis and cite lack of awareness and physician nonreferral as barriers. Further research is needed to understand patients' needs and beliefs regarding SPCS, and how to integrate SPCS into conventional treatments to improve cancer care.
Division of Geriatric and Palliative Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street / 2 Gates, Philadelphia, PA 19104, USA.
Pallavi
P
Kumar
David
D
Casarett
Amy
A
Corcoran
Krupali
K
Desai
Qing
Q
Li
Jinbo
J
Chen
Corey
C
Langer
Jun J
JJ
Mao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010414:Pennsylvania; D011788:Quality of Life; D055815:Young Adult