Timing of referral and characteristics of uninsured, Medicaid, and insured patients referred to the outpatient supportive care center at a comprehensive cancer center

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AZHAR, Ahsan | YENNURAJALINGAM, Sriram | RAMU, Aashraya | ZHANG, Haibo | HAIDER, Ali | WILLIAMS, Janet L. | DIBAJ, Seyedeh S. | LIU, Diane D. | BRUERA, Eduardo

CONTEXT: Low-income patients face barriers to palliative care access, which might negatively influence symptom management and advanced care planning. OBJECTIVE: Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patients presenting to our Supportive Care Center (SCC). METHODS: We conducted a retrospective review of randomly selected 100 indigent, 100 Medicaid and 300 insured outpatients referred during the same 5-year period. We reviewed demographic and clinical characteristics including date of diagnosis of advanced cancer and of first visit to SCC, symptom assessment (Edmonton Symptom Assessment System; ESAS), type and dose of opioid medication, number of total outpatient visits, and date of last contact with palliative care team. RESULTS: Among 482 evaluable patients, indigent, Medicaid, and insured patients respectively had mean (SD) ages of 48 (11), 50 (12), and 63 (13) years [p<0.001], ESAS pain scores at first visit of 6.7 (2.5), 5.6 (3.2), and 4.9 (3.2) [p<0.001], non-white race in 60%, 49%, and 25% of cases [p<0.001], unmarried status in 68%, 64%, and 33% of cases [p<0.001], while 63%, 87%, and 54% of patients [p<0.001] were on opioids with median number of encounters per month of 0.6, 0.8 and 0.5 [p=0.001]. Median survival (95% CI) from first visit to last contact was 4.6 (2.8-6.2), 5.4 (3.5-7), and 5.6 (4.7-7.3) months [p=0.036]. CONCLUSION: Patients with limited or no insurance had significantly higher pain, were more frequently on opioids, younger, non-white, and not married. They required higher number of SCC follow-up visits. Insurance status did not affect timing of SCC referral or follow-ups at our cancer center.

http://dx.doi.org/10.1016/j.jpainsymman.2017.10.025

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 55»

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