Grant Number:	4R37CA246565-06 Interpret this number
Primary Investigator:	Hua, May
Organization:	Columbia University Health Sciences
Project Title:	Determinants of Palliative Care Effectiveness for Patients with Metastatic Cancer
Fiscal Year:	2026

Project Summary Palliative care is an interdisciplinary model of care with the overarching goal of improving quality of life for patients with serious illness through symptom management, provision of psychosocial support, elicitation of preferences and aiding decision-making. The American Society of Clinical Oncology guidelines recommend early integration of specialist palliative care for patients with advanced cancer, and use of specialist palliative care has been associated with improved end-of-life quality metrics for patients with cancer on a population- level. Thus, the importance of specialist palliative care as a key component of high-quality cancer care has been established. Despite its demonstrated effectiveness and inclusion in national guidelines, disparities in receipt of specialist palliative care may exist. In patients with cancer, studies have demonstrated disparities in other guideline-concordant treatments, as well as in end-of-life care. Because of the difficulty in identifying receipt of specialist palliative care in population-level data, prior studies examining disparities have only used single-center data, examined flawed proxies for palliative care such as delivery of non-curative treatment, or palliative care not specifically delivered by specialists. In our R37 MERIT award, we created a novel national database comprised of Medicare claims, data on palliative care program characteristics from the National Palliative Care Registry, and prospectively collected data on palliative care clinicians that allow for accurate ascertainment of specialist palliative care use. These data provide an unprecedented opportunity to investigate disparities in access to specialist palliative care, related outcomes, and potential drivers of disparities. The proposed research will target important knowledge gaps by providing 1) a determination of the extent that disparities in specialist palliative care use exist in a large, multicenter, national cohort across a broad population of patients with metastatic cancer, 2) a quantification of the consequences of disparities with respect to end-of-life quality metrics, and 3) an investigation of potential causes of disparities that may guide future directions of research aimed at ameliorating disparities. This project represents a critical scientific advance in understanding how to ensure the equitable delivery of high-quality care for all patients with cancer.