Trends and Predictors of Palliative Therapy Use in Young Adults with Advanced Gastrointestinal Cancer - National Cancer Database Study

Q: What does the study investigate about palliative therapy in young adults?

It examines temporal trends and identifies predictors of palliative therapy utilization among young adults with advanced gastrointestinal cancer.

Q: How was the study conducted?

A retrospective cohort study used the National Cancer Database, with trend analysis followed by univariable and multivariable logistic regression.

Q: What key factors were associated with higher palliative therapy use?

Higher utilization was linked to non-White/non-Black race, no insurance, lower median income, multiple comorbidities, stage IV disease, and several primary cancer sites including esophagus, liver, pancreas, and biliary tract.

Sep 23, 2026

Uploaded by Jake

Young adults (18–39) with advanced gastrointestinal cancer face distinct clinical and psychosocial needs that may be addressed through palliative therapy. This retrospective cohort study uses the National Cancer Database to quantify temporal trends in palliative therapy utilization from 2004–2020 and to identify predictors using trend analysis plus univariable and multivariable logistic regression. Among 43,616 patients, 8.76% received palliative therapy, with significant increase from 2004 to 2020, and higher use linked to non-White/non-Black race, no insurance, lower median income, multiple comorbidities, stage IV disease, and specific primary cancer sites.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background and Objectives

Methods

Results

Conclusions

Ann Surg Oncol (2025) 32:4261–4271 [https://doi.org/10.1245/s10434-025-17074-6](https://doi.org/10.1245/s10434-025-17074-6) ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY Trends and Predictors of Palliative Therapy Use in Young Adults with Advanced Gastrointestinal Cancer: A National Cancer Database Study Olivia Monton, MD, ScM1,2,3, Kimberly Kopecky, MD, MSCI4, Andrei Gurau, MD, MHS, MS1, Orly N. Farber, MD5,6, Elizabeth J. Lilley, MD, MPH5,6,7,8, Jonathan B. Greer, MD9, and Fabian M. Johnston, MD, MHS10 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Department of Surgery, McMaster University, Hamilton, ON, Canada; 4Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; 5Department of Surgery, Brigham and Women’s Hospital, Boston, MA; 6Center for Surgery and Public Health at Brigham and Women’s Hospital, Boston, MA; 7Department of Psychological Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; 8Harvard Medical School, Boston, MA; 9Department of Surgery, Massachusetts General Hospital, Boston, MA; 10Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC ABSTRACT Background. Young adults (YAs) with advanced gastrointestinal (GI) cancer have unique care needs, which may be addressed through palliative therapy. Objectives. The aims ofthis study were to describe temporal trends and identify predictors of palliative therapy utilization in YAs with advanced GI cancer. Methods. We conducted a retrospective cohort study using the National Cancer Database. YAs (18–39 years of age) diagnosed with advanced GI cancer from 2004 to 2020 were identified. We performed a trend analysis followed by univariable and multivariable logistic regression analyses. Results. A total of 43,616 YAs with advanced GI cancer were identified, of whom 3820 (8 .76%) were treated with palliative therapy. The proportion of patients who received palliative therapy increased significantly, from 5. 33% in 2004 to 12. 36% in 2020 (ptrend < 0 .05) . Patients of non-White/non-Black race (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.09–1.40), with no insurance (OR © The Author(s) 2025 First Received: 5 August 2024 Accepted: 7 February 2025 Published online: 3 March 2025 F. M. Johnston, MD, MHS e-mail: [fajohnst@wakehealth.edu](fajohnst@wakehealth.edu) 1.35, 95% CI 1.20–1.53), and with a median income of less than $63,000 (OR 1.20, 95% CI 1.08–1.34) were more likely to receive palliative therapy. Multiple comorbidities (OR 1.59, 95% CI 1.24–2.06), stage IV disease (OR 8.28, 95% CI 7.33–9.34), and cancers ofthe esophagus (OR 2.26, 95% CI 1.88–2.71), liver (OR 2.19, 95% CI 1.88–2.56), pancreas (OR 2.20, 95% CI 1.53–3.16), and biliary tract (OR 2.12, 95% CI 1.54–2.91) were also predictors of palliative therapy utilization. Conclusions. Palliative therapy utilization in YAs with advanced GI cancer increased significantly over the study period, however major gaps remain in the provision of this care. Further work is needed to understand the barriers to access among YAs. Keywords Palliative care · Palliative therapy · Young adults · Gastrointestinal cancer Young adults (YAs), aged 18–39 years, represent an understudied patient population within oncology, with research lagging behind that of other age groups.1 This gap raises concerns given the increasing incidence of cancer among YAs in the United States (US) .2 From 1999 to 2020, there were an estimated 73,954 deaths from gastrointestinal (GI) cancer in YAs in the US alone, translating to an age-adjusted mortality rate of 3.3 per 100,000 .3 Globally, approximately 131,068 new cases of GI cancer and 79,614 GI cancer-related deaths were reported among YAs in the year 2000, representing approximately 12% of new cancer cases

FAQs

What does the study investigate about palliative therapy in young adults?

It examines temporal trends and identifies predictors of palliative therapy utilization among young adults with advanced gastrointestinal cancer.

How was the study conducted?

A retrospective cohort study used the National Cancer Database, with trend analysis followed by univariable and multivariable logistic regression.

What key factors were associated with higher palliative therapy use?

Higher utilization was linked to non-White/non-Black race, no insurance, lower median income, multiple comorbidities, stage IV disease, and several primary cancer sites including esophagus, liver, pancreas, and biliary tract.

Sep 23, 2026

Uploaded by Jake