Background: Guidelines recommend early specialty palliative care for patients with advanced cancer, but receipt is low in the US, potentially reflecting inadequate access. This study examines the association of geographic accessibility to palliative care physicians and receipt of palliative care as part of initial treatment among individuals with stage IV cancer in the U.S. Methods: Adults aged ≥18 years newly diagnosed with stage IV cancer between 2018-2019 in the contiguous US were identified from the National Cancer Database (NCDB). Medicare physicians who specialize in Hospice and Palliative Care were identified from the 2018-2019 CMS Medicare Physician and Other Practitioners dataset. We calculated a geographic accessibility score using the two-step floating catchment area (2SFCA) method, based on patients’ residence zip codes and physicians’ zip codes and road network, accounting for physician supply and patient demand. Multivariable logistic regression models examined associations of the geographic accessibility score quartiles and receipt of palliative care (abstracted from patients’ medical records including pain management, surgery, radiation, systemic or other therapy administered to alleviate symptoms). Supplemental analyses were conducted among patients who died within 180 days from diagnosis. Results: We identified and geocoded 333,127 patients with stage IV cancer and 1,063 palliative care physicians. Patients living in nonmetropolitan, socioeconomically deprived areas, living in the Southern US, or being treated at community facilities had lower accessibility to palliative care physicians. In adjusted analysis, patients with higher geographic accessibility to palliative care physicians were more likely to receive palliative care compared with those with lower geographic accessibility, among all and patients died within 180 days from diagnosis (Table). Conclusions: Higher geographic accessibility to palliative care physicians was associated with a greater likelihood of palliative care receipt among patients diagnosed with advanced cancer. Findings support the need for strategies to increase number of palliative care physicians, especially in rural and socioeconomically deprived areas, to enhance the accessibility of guideline-recommended palliative care.

Presented are % received palliative care and adjusted odds ratios (95%CI).