{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:07:37Z","timestamp":1790784457156,"version":"4.1.0"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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\u2019 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.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Medicare plan type.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 135\u202f402 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];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), particularly those in a health maintenance organization (HMO) plan (AHR, 1.66 [95% CI, 1.60-1.73];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). After matching, there were no overall differences between MA and TM in PC receipt (AHR, 1.05 [95% CI, 0.98-1.12];\n P<\/jats:italic>\n \u2009=\u2009.19), and the AHR was attenuated for HMO plans vs TM (AHR, 1.16 [95% CI, 1.08-1.24];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Medicare Advantage beneficiaries had lower systemic therapy receipt (adjusted probability difference, \u22125.38 percentage points [pp]; 95% CI, \u22126.02 to \u22124.74 pp;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and higher hospice enrollment (3.42 pp; 95% CI, 2.82-4.03 pp;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) than TM beneficiaries; differences persisted after matching (systemic therapy: \u22125.70 pp [95% CI, \u22126.89 to \u22124.52 pp];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001; hospice enrollment: 1.68 pp [95% CI, 0.56-2.80 pp];\n P<\/jats:italic>\n \u2009=\u2009.003).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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\u2013level features beyond physician networks and patient characteristics may be associated with these outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.36865","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:31:57Z","timestamp":1790782317000},"page":"e2636865","source":"Crossref","is-referenced-by-count":0,"title":["Palliative Care for Advanced Cancer in Medicare Advantage and Physician Networks"],"prefix":"10.1001","volume":"9","author":[{"given":"Xin","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, Georgia"},{"name":"Winship Cancer Institute, Emory University, Atlanta, Georgia"},{"name":"Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changchuan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youngmin","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinjin","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kewei Sylvia","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingxuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig Evan","family":"Pollack","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland"},{"name":"School of Nursing, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Blackford","sequence":"additional","affiliation":[{"name":"Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan L.","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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