Palliative care access still limited for advanced cancer patients

Despite increases in telehealth and a larger healthcare workforce, many Medicare beneficiaries with poor-prognosis cancers still lack access to specialty palliative care – AI image generated by Gemini

CANCER DIGEST – JULY 26, 2025 – A new study analyzing Medicare beneficiaries who died from poor-prognosis cancers between 2018 and 2023 reveals that while specialty palliative care for advanced cancer is increasing, it remains low, particularly among disadvantaged groups.

Led by Isaac Chua, MD, MPH, of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, the study findings were published July 24, 2025 in JAMA Network Open.

The research explored the impact of telehealth adoption and the expansion of the advanced practice clinician workforce to better understand the barriers to cancer care for those who need it most. The results showed that despite telehealth growth and a larger healthcare workforce, many Medicare beneficiaries with poor-prognosis cancers still lack access to specialty palliative care.

Palliative care is specialized medical care for people living with serious illnesses focused on improving quality of life by managing symptoms and stress. Early specialty palliative care is recognized as the standard of care for cancer patients. However, many individuals with advanced cancer do not consistently receive these crucial services, especially in the early stages of their diagnosis.

The study examined medical records of over 1.5 million U.S. Medicare fee-for-service beneficiaries who died from poor-prognosis cancers over the five-year period. It assessed the proportion of decedents who received any specialty palliative care in their last year of life, prior to hospice enrollment.

The study also detailed changes in care delivery by modality (in-person vs. telehealth), setting (hospital vs. outpatient), and clinician type (physician vs. advanced practice clinicians), while also exploring associations between patient characteristics and care receipt. Advanced practice clinicians include nurse practitioners and physicians' assistants, as well as others with advanced education and training.

The findings indicate a small (24 percent) but growing proportion of Medicare beneficiaries received specialty palliative care in the year before their death. By the end of 2023, however, only just over one-third of decedents had received any non-hospice palliative care in their final year. Outpatient palliative care visits, including telehealth, nearly doubled, largely driven by advanced practice clinician specialists, who have largely supplanted physicians as the primary providers of outpatient specialty palliative care.

Despite these shifts, certain disadvantaged groups—including older decedents, those with lower incomes, or individuals living in nonmetropolitan areas—were still less likely to receive specialty palliative care. The study's implications suggest that while telehealth appears well-suited for palliative care delivery, and its persistent use is notable, additional strategies are needed to overcome access barriers.

The next steps for researchers involve identifying and understanding the specific reasons for persistently low specialty palliative care use in these vulnerable patient populations. Thoughtful policy and system-based interventions will likely be essential to ensure all patients with poor-prognosis cancers have equitable access to these vital services.

Source: AI generated by Gemini based on Mass General Hospital press release and JAMA Network Open