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Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center

Background: The American Society of Clinical Oncology's recommendation for “dedicated palliative care services, early in the disease course, concurrent with active treatment” for cancer patients is a challenge for cancer centers to accommodate. Despite demonstrated benefits of concurrent care,...

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Autores principales: Cervantez, Sherri Rauenzahn, Tenner, Laura L., Schmidt, Susanne, Aduba, Ifeoma O., Jones, Jessica T., Ali, Nazneen, Singh-Carlson, Savitri
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196262/
https://www.ncbi.nlm.nih.gov/pubmed/30374422
http://dx.doi.org/10.3389/fonc.2018.00443
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author Cervantez, Sherri Rauenzahn
Tenner, Laura L.
Schmidt, Susanne
Aduba, Ifeoma O.
Jones, Jessica T.
Ali, Nazneen
Singh-Carlson, Savitri
author_facet Cervantez, Sherri Rauenzahn
Tenner, Laura L.
Schmidt, Susanne
Aduba, Ifeoma O.
Jones, Jessica T.
Ali, Nazneen
Singh-Carlson, Savitri
author_sort Cervantez, Sherri Rauenzahn
collection PubMed
description Background: The American Society of Clinical Oncology's recommendation for “dedicated palliative care services, early in the disease course, concurrent with active treatment” for cancer patients is a challenge for cancer centers to accommodate. Despite demonstrated benefits of concurrent care, disparities among socioeconomic and ethnic groups in access to supportive care services have been described. The aim of this project was to evaluate: (a) how insurance coverage and ethnicity impact patient symptom burden and, (b) how those factors influence palliative access for patients at a South Texas NCI-designated cancer center. Methods: During a 5-month prospective period, 604 patients from five ambulatory oncology clinics completed the 10 question Edmonton Symptom Assessment Scale (ESAS) surveys during their clinic visit. Patient demographics, ESAS scores, palliative referral decisions, and time to palliative encounters were collected. We compared symptom burden and time to consult based on ethnicity and insurance status (insured = Group A; under-insured and safety net = Group B). Results: The mean ESAS score for all patients at the initial visit was 19.9 (SD = 18.1). Safety net patients were significantly more likely to be Hispanic, younger in age, and have an underlying GI malignancy in comparison to insured patients; however, the symptom severity was similar between groups with over 40% of individuals reporting at least one severe symptom. Twenty-one referrals were made to palliative care. On average, Group B had 33.3 days longer wait times until their first potential visit (p < 0.01) when compared to Group A. Time to actual visit was on average 57.6 days longer for patients in Group B compared to patients in Group A (p = 0.01), averaging at 73.8 days for safety net patients. Conclusions: This project highlights the high symptom burden of oncology patients and disparities in access to services based on insurance coverage. This investigation revealed a 4-fold increase in the time to the first scheduled palliative care visit based on whether patients were insured vs. under-insured. While this study is limited by a small sample size, data suggest that under-insured oncology patients may have significant barriers to palliative care services, which may influence their cancer care quality.
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spelling pubmed-61962622018-10-29 Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center Cervantez, Sherri Rauenzahn Tenner, Laura L. Schmidt, Susanne Aduba, Ifeoma O. Jones, Jessica T. Ali, Nazneen Singh-Carlson, Savitri Front Oncol Oncology Background: The American Society of Clinical Oncology's recommendation for “dedicated palliative care services, early in the disease course, concurrent with active treatment” for cancer patients is a challenge for cancer centers to accommodate. Despite demonstrated benefits of concurrent care, disparities among socioeconomic and ethnic groups in access to supportive care services have been described. The aim of this project was to evaluate: (a) how insurance coverage and ethnicity impact patient symptom burden and, (b) how those factors influence palliative access for patients at a South Texas NCI-designated cancer center. Methods: During a 5-month prospective period, 604 patients from five ambulatory oncology clinics completed the 10 question Edmonton Symptom Assessment Scale (ESAS) surveys during their clinic visit. Patient demographics, ESAS scores, palliative referral decisions, and time to palliative encounters were collected. We compared symptom burden and time to consult based on ethnicity and insurance status (insured = Group A; under-insured and safety net = Group B). Results: The mean ESAS score for all patients at the initial visit was 19.9 (SD = 18.1). Safety net patients were significantly more likely to be Hispanic, younger in age, and have an underlying GI malignancy in comparison to insured patients; however, the symptom severity was similar between groups with over 40% of individuals reporting at least one severe symptom. Twenty-one referrals were made to palliative care. On average, Group B had 33.3 days longer wait times until their first potential visit (p < 0.01) when compared to Group A. Time to actual visit was on average 57.6 days longer for patients in Group B compared to patients in Group A (p = 0.01), averaging at 73.8 days for safety net patients. Conclusions: This project highlights the high symptom burden of oncology patients and disparities in access to services based on insurance coverage. This investigation revealed a 4-fold increase in the time to the first scheduled palliative care visit based on whether patients were insured vs. under-insured. While this study is limited by a small sample size, data suggest that under-insured oncology patients may have significant barriers to palliative care services, which may influence their cancer care quality. Frontiers Media S.A. 2018-10-15 /pmc/articles/PMC6196262/ /pubmed/30374422 http://dx.doi.org/10.3389/fonc.2018.00443 Text en Copyright © 2018 Cervantez, Tenner, Schmidt, Aduba, Jones, Ali and Singh-Carlson. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Cervantez, Sherri Rauenzahn
Tenner, Laura L.
Schmidt, Susanne
Aduba, Ifeoma O.
Jones, Jessica T.
Ali, Nazneen
Singh-Carlson, Savitri
Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center
title Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center
title_full Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center
title_fullStr Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center
title_full_unstemmed Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center
title_short Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center
title_sort symptom burden and palliative referral disparities in an ambulatory south texas cancer center
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196262/
https://www.ncbi.nlm.nih.gov/pubmed/30374422
http://dx.doi.org/10.3389/fonc.2018.00443
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