Trends and Determinants of Palliative Care Utilization Among Patients With Metastatic Upper Tract Urothelial Carcinoma in the National Cancer Database

Objective To identify patterns of palliative care usage and identify determinants of palliative intervention using a large contemporary cohort of patients with metastatic upper tract urothelial carcinoma (mUTUC). Methods: The National Cancer Database was queried from 2004 to 2020 for patients with mUTUC. Patients with a prior malignancy, non-mUTUC, and missing follow up or palliative care information were excluded. Demographics and baseline characteristics were compared between patients with mUTUC who received palliative care and those that did not. Trends in annual palliative care usage were assessed via logistic regression. Univariate and multivariate logistic regression models were used to identify predictors of receipt of palliative care. Results: Four thousand and forty-four patients with mUTUC were included in the final cohort, among which 908 received palliative care (22.5%) and 3136 did not (77.5%). We found that the utilization of palliative care increased significantly from 2004 (15.0%) to 2019 (23.1%), P < .001. Additionally, on multivariate analysis we found that a recent year of diagnosis, receipt of a prior nonsurgical treatment paradigm, and an overall survival <6 months were independent predictors of palliative intervention, all P < .001. On the other hand, undergoing treatment at a minority serving hospital and older age were associated with lower likelihood of receiving palliative care, both P < .001. Conclusions: There is a low but increasing trend of utilization of palliative care among patients with mUTUC. Expansion of palliative care services, particularly among older patients and those at minority-serving hospitals, remains a key opportunity to improve quality of life and enhance patient-centered care among those with mUTUC.