Breast cancer patients often lack access to palliative care services, but the needle may be moving as researchers dig into common barriers and clinical and financial outcomes.
A recent study of nearly 30,000 hospitalized metastatic breast cancer patients found that only 19% received palliative care from 2010 to 2014. The Scientific Reports study examined patient data in the U.S. National Inpatient Sample, a database that includes inpatient records across 48 states and the District of Columbia.
Those breast cancer patients who were able to receive palliative care experienced fewer hospitalizations and greater social support, which in turn reduced health care costs., the researchers indicated.
“Results showed that patients with palliative care were associated with 31% lower hospital charges,” the authors wrote in the study. “This study found social differences and gave evidence of programs that could be used to help vulnerable groups in future health policy decisions.”
Common barriers to palliative care among breast cancer patients are reflective of those among the general population and include factors such as race and insurance type, the researchers found.
Other studies have found a lack of awareness as another barrier to palliative care utilization among underserved breast cancer patients, including those from varied racial and ethnic backgrounds.
Other potential barriers include cultural beliefs, poor awareness and physician preferences that can influence whether minority patients receive palliative care services during metastatic breast cancer treatment, according to research from the American Association for Cancer Research.
Non-Hispanic Black, Latino, American Indian and Asian or Pacific Islander patients with metastatic breast cancer were less likely to receive this care than white patients from 2004 to 2020, the study found. The research measured palliative care utilization among nearly 150,000 patients from these racial and ethnic groups across 1,500 cancer treatment centers nationwide.
Despite lagging utilization rates, palliative care use has “increased over time” among minority patients, researchers said.
“Our findings underscore the importance of promoting the benefits of palliative care and addressing racial/ethnic disparities to improve the quality of life of metastatic breast cancer patients,” researcher Jincong Freeman, a doctoral student in the department of public health sciences at the University of Chicago, said in a statement. “It is essential to identify the needs of these patients, particularly racial/ethnic minority populations, and evaluate how oncology programs can integrate palliative care early into the cancer care continuum while ensuring equitable access.”
It is essential to identify the needs of these patients, particularly racial/ethnic minority populations, and evaluate how oncology programs can integrate palliative care early into the cancer care continuum while ensuring equitable access.
— Jincong Freeman, researcher and doctoral student, University of Chicago
Access to palliative care can help breast cancer patients navigate the various challenges of their disease trajectory, according to Dr. Deepthi TR, a specialist in early cancer detection and prevention for India-based Oncure Bio Solutions.
Palliative care services can help reduce family caregiver burnout and burden and also assist with mental health support to address the different emotional stages of shock, denial, anger, sadness and acceptance of a breast cancer diagnosis, TR indicated in a OnManorama article. Additionally, palliative care utilization can reduce family caregiver burnout and burden.
“It’s essential to recognize the significant stress that caregiving can place on family members,” TR said. “Patients, families, and healthcare providers must engage in open conversations about the patient’s preferences, pain management and emotional support. It’s a challenging time that requires sensitivity and compassion. Its effectiveness in improving the well-being of patients with advanced cancer, emphasizes the need for early integration of palliative care into cancer treatment.”
Palliative care providers can add a layer of critical support for metastatic breast cancer patients, particularly those experiencing depression, anxiety and stress associated with their serious illness, according to Dr. Beth Popp, oncologist and palliative care physician in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai.
Breast cancer patients that receive palliative services can have improved quality of life over the course of their disease trajectory, Popp stated in a recent article from the Center to Advance Palliative Care (CAPC).
“As palliative care clinicians, we can and should give patients the ‘permission’ and space to feel their feelings and share their concerns, whatever they may be, and help them improve their quality of life,” Popp said. “Breast cancer patients often experience depression, anxiety, and stress. We must also understand the toll breast cancer and its treatment can take on self-image. For some, this means talking to a mental health professional about their psychological distress. Others may benefit from a peer support group, because connecting with others who know what they’re going through can be comforting.”
