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Peer-reviewedCC BY 4.0JAMA Network Open

Palliative Care for Advanced Cancer in Medicare Advantage and Physician Networks

  • Xin Hu1,2,3
  • Changchuan Jiang4
  • Youngmin Kwon5
  • Qinjin Fan6
  • Kewei Sylvia Shi6
  • Zhiyuan Zheng6
  • Jingxuan Zhao6
  • Craig Evan Pollack7,8
  • Amanda L. Blackford9
  • Joan L. Warren6
  • Xuesong Han6
  • K. Robin Yabroff6
9 affiliations
  1. 1Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, Georgia
  2. 2Winship Cancer Institute, Emory University, Atlanta, Georgia
  3. 3Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
  4. 4Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
  5. 5Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
  6. 6Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia
  7. 7Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  8. 8School of Nursing, Johns Hopkins University, Baltimore, Maryland
  9. 9Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Importance: Palliative care (PC) is guideline recommended to improve symptoms and quality of life concurrent with cancer-directed therapy for patients with advanced cancer, yet utilization remains low among Medicare beneficiaries. While Medicare Advantage (MA) enrollment has surpassed traditional Medicare (TM), how PC and other health care utilization differs between MA and TM for beneficiaries with advanced cancer is unknown.

Objective: To compare PC, systemic therapy, and hospice utilization among patients with advanced cancer covered by MA vs TM and evaluate whether differences are associated with physician network composition.

Design, Setting, and Participants: This retrospective cohort study used linked Surveillance, Epidemiology, and End Results (SEER) and Medicare data for beneficiaries aged 66 years or older diagnosed with distant-stage breast, colorectal, lung, pancreatic, or prostate cancer from January 1, 2016, to December 31, 2021, who had continuous MA or TM enrollment and at least 2 months’ survival. Beneficiaries were followed up from diagnosis until the earlier of death or December 31, 2021. Each beneficiary was assigned a treating oncologist; MA beneficiaries within each plan were matched 1:1 to TM beneficiaries based on treating oncologists. Data were analyzed from November 18, 2025, to July 26, 2026.

Exposure: Medicare plan type.

Main Outcomes and Measures: Time to first PC, systemic therapy, and hospice utilization. Multivariable models estimated the associations between MA enrollment and outcomes before and after matching on treating oncologist, adjusting for sociodemographic and clinical characteristics.

Results: Among 135 402 eligible beneficiaries, 32.3% were enrolled in MA and 67.7% in TM; mean (SD) age was 76.2 (6.7) years, and 53.3% were male. Medicare Advantage beneficiaries had higher 6-month cumulative incidence of PC compared with TM beneficiaries (13.3% vs 9.3%; adjusted hazard ratio [AHR], 1.39 [95% CI, 1.35-1.44]; P < .001), particularly those in a health maintenance organization (HMO) plan (AHR, 1.66 [95% CI, 1.60-1.73]; P < .001). After matching, there were no overall differences between MA and TM in PC receipt (AHR, 1.05 [95% CI, 0.98-1.12]; P = .19), and the AHR was attenuated for HMO plans vs TM (AHR, 1.16 [95% CI, 1.08-1.24]; P < .001). Medicare Advantage beneficiaries had lower systemic therapy receipt (adjusted probability difference, −5.38 percentage points [pp]; 95% CI, −6.02 to −4.74 pp; P < .001) and higher hospice enrollment (3.42 pp; 95% CI, 2.82-4.03 pp; P < .001) than TM beneficiaries; differences persisted after matching (systemic therapy: −5.70 pp [95% CI, −6.89 to −4.52 pp]; P < .001; hospice enrollment: 1.68 pp [95% CI, 0.56-2.80 pp]; P = .003).

Conclusions and Relevance: In this retrospective cohort study of Medicare beneficiaries with advanced cancer, MA enrollment was associated with increased PC utilization, primarily attributable to differential oncologist network composition. Persistent differences in systemic therapy use and hospice enrollment after matching by treating oncologists suggest that MA plan–level features beyond physician networks and patient characteristics may be associated with these outcomes.

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Cite

BibTeXRIS
BibTeX
@article{hu2026palliative,
  title = {{Palliative Care for Advanced Cancer in Medicare Advantage and Physician Networks}},
  author = {Xin Hu and Changchuan Jiang and Youngmin Kwon and Qinjin Fan and Kewei Sylvia Shi and Zhiyuan Zheng and Jingxuan Zhao and Craig Evan Pollack and Amanda L. Blackford and Joan L. Warren and Xuesong Han and K. Robin Yabroff},
  journal = {JAMA Network Open},
  year = {2026},
  month = sep,
  doi = {10.1001/jamanetworkopen.2026.36865},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854646},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Palliative Care for Advanced Cancer in Medicare Advantage and Physician Networks
AU  - Xin Hu
AU  - Changchuan Jiang
AU  - Youngmin Kwon
AU  - Qinjin Fan
AU  - Kewei Sylvia Shi
AU  - Zhiyuan Zheng
AU  - Jingxuan Zhao
AU  - Craig Evan Pollack
AU  - Amanda L. Blackford
AU  - Joan L. Warren
AU  - Xuesong Han
AU  - K. Robin Yabroff
PY  - 2026
DA  - 2026/09/30
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.36865
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854646
AB  - Importance: Palliative care (PC) is guideline recommended to improve symptoms and quality of life concurrent with cancer-directed therapy for patients with advanced cancer, yet utilization remains low among Medicare beneficiaries. While Medicare Advantage (MA) enrollment has surpassed traditional Medicare (TM), how PC and other health care utilization differs between MA and TM for beneficiaries with advanced cancer is unknown.  Objective: To compare PC, systemic therapy, and hospice utilization among patients with advanced cancer covered by MA vs TM and evaluate whether differences are associated with physician network composition.  Design, Setting, and Participants: This retrospective cohort study used linked Surveillance, Epidemiology, and End Results (SEER) and Medicare data for beneficiaries aged 66 years or older diagnosed with distant-stage breast, colorectal, lung, pancreatic, or prostate cancer from January 1, 2016, to December 31, 2021, who had continuous MA or TM enrollment and at least 2 months’ survival. Beneficiaries were followed up from diagnosis until the earlier of death or December 31, 2021. Each beneficiary was assigned a treating oncologist; MA beneficiaries within each plan were matched 1:1 to TM beneficiaries based on treating oncologists. Data were analyzed from November 18, 2025, to July 26, 2026.  Exposure: Medicare plan type.  Main Outcomes and Measures: Time to first PC, systemic therapy, and hospice utilization. Multivariable models estimated the associations between MA enrollment and outcomes before and after matching on treating oncologist, adjusting for sociodemographic and clinical characteristics.  Results: Among 135 402 eligible beneficiaries, 32.3% were enrolled in MA and 67.7% in TM; mean (SD) age was 76.2 (6.7) years, and 53.3% were male. Medicare Advantage beneficiaries had higher 6-month cumulative incidence of PC compared with TM beneficiaries (13.3% vs 9.3%; adjusted hazard ratio [AHR], 1.39 [95% CI, 1.35-1.44]; P < .001), particularly those in a health maintenance organization (HMO) plan (AHR, 1.66 [95% CI, 1.60-1.73]; P < .001). After matching, there were no overall differences between MA and TM in PC receipt (AHR, 1.05 [95% CI, 0.98-1.12]; P = .19), and the AHR was attenuated for HMO plans vs TM (AHR, 1.16 [95% CI, 1.08-1.24]; P < .001). Medicare Advantage beneficiaries had lower systemic therapy receipt (adjusted probability difference, −5.38 percentage points [pp]; 95% CI, −6.02 to −4.74 pp; P < .001) and higher hospice enrollment (3.42 pp; 95% CI, 2.82-4.03 pp; P < .001) than TM beneficiaries; differences persisted after matching (systemic therapy: −5.70 pp [95% CI, −6.89 to −4.52 pp]; P < .001; hospice enrollment: 1.68 pp [95% CI, 0.56-2.80 pp]; P = .003).  Conclusions and Relevance: In this retrospective cohort study of Medicare beneficiaries with advanced cancer, MA enrollment was associated with increased PC utilization, primarily attributable to differential oncologist network composition. Persistent differences in systemic therapy use and hospice enrollment after matching by treating oncologists suggest that MA plan–level features beyond physician networks and patient characteristics may be associated with these outcomes.
SN  - 2574-3805
ER  -