Disparities in Supportive Care Utilization Among Neurosurgical Patients With Malignant Central Nervous System Tumors

INTRODUCTION: Patients with central nervous system (CNS) malignancies benefit from palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines also propose early PC for patients with advanced cancers. Racial disparities exist in healthcare access, and we introduce a novel construct, “provider patient racial diversity index” (provider pRDI), higher categories of which refer to higher proportions of non-white patients a provider sees as a measure of the provider’s exposure to racial diversity and cultural sensitivity. METHODS: Using Optum Clinformatics Datamart Database, all patients with at least one neurosurgery encounter, diagnosis of primary or secondary CNS malignancy, and no prior supportive services were included. Patient-level demographics were collated. Supportive services were defined based on provider categorization on individual claims. RESULTS: The cohort of 48,722 patients demonstrated significantly low rates of PC, home health, and social work services among racial minorities. However, patients who saw providers categorized into high provider pRDI categories were increasingly more likely to interface with supportive services and at an earlier point in their disease courses. Patient race did not impact supportive service spending, but higher provider pRDI was associated with monotonic increases in spending on PC. CONCLUSIONS: Neurosurgical patients with CNS malignancies from minority backgrounds are less likely to receive supportive services. Such effect is mitigated when they encounter at least one provider who scores highly in provider pRDI; patients receive supportive services earlier and demonstrate greater utilization. Our study highlights patient-level healthcare disparities and the need for provider-level intervention to address cultural sensitivity.