Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer |
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| Authors: | Laura M. Perry Leah E. Walsh Ronald Horswell Lucio Miele San Chu Brian Melancon John Lefante Christopher M. Blais James L. Rogers Michael Hoerger |
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| Affiliation: | 1. Tulane University, New Orleans, Louisiana, USA;2. Fordham University, New York, New York, USA;3. Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA;4. LSU Health Sciences Center, New Orleans, Louisiana, USA;5. Ochsner Medical Center, New Orleans, Louisiana, USA;1. Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. Albany Medical College, Albany, New York, USA;3. Department of Gynecologic Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA;1. Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA;2. Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA;3. Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA;4. Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John''s, Newfoundland and Labrador, Canada;5. Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA;6. Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA;7. Northwell Health NCORP, Lake Success, New York, USA;8. Columbus NCORP, Columbus, Ohio, USA;9. Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA;10. Heartland Cancer Research NCORP, Decatur, Illinois, USA;11. Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA;1. Ewdomed Ewa Szulecka Foundation and Home Hospice, Konstancin-Jeziorna, Poland;2. Clinical Department of Oncology and Radiotherapy, Central Clinical Hospital of the MSWiA in Warsaw, Warsaw, Poland;3. Centre of Postgraduate Medical Education, Warsaw, Poland;1. Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada;2. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada;3. Division of Nephrology, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;4. Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;5. Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;6. Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada |
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| Abstract: | ContextThe comfort of patients with cancer near the end of life (EOL) is often undermined by unnecessary and burdensome treatments. There is a need for more research examining racial disparities in EOL care, especially in regions with a history of racial discrimination.ObjectivesTo examine whether black adults received more burdensome EOL care than white adults in a population-based data set of cancer decedents in Louisiana, a state with a history of slavery and long-standing racial disparities.MethodsThis was a retrospective analysis of EOL care from the Research Action for Health Network (REACHnet), a regional Patient-Centered Outcomes Research Institute-funded database. The sample consisted of 875 white and 415 black patients with metastatic cancer who died in Louisiana from 2011 to 2017. We used logistic regression to examine whether race was associated with five indicators of burdensome care in the last 30 days of life: chemotherapy use, inpatient hospitalization, intensive care unit admission, emergency department (ED) admission, and mechanical ventilation.ResultsMost patients (85.0%) received at least one indicator of burdensome care: hospitalization (76.5%), intensive care unit admission (44.1%), chemotherapy (29.1%), mechanical ventilation (23.0%), and ED admission (18.3%). Odds ratios (ORs) indicated that black individuals were more likely than white individuals to be hospitalized (OR = 1.66; 95% CI = 1.21–2.28; P = 0.002) or admitted to the ED (OR = 1.57; 95% CI = 1.16–2.13; P = 0.004) during their last month of life.ConclusionFindings have implications for informing health care decision making near the EOL for patients, families, and clinicians, especially in regions with a history of racial discrimination and disparities. |
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| Keywords: | Neoplasms minority health racism terminal care palliative medicine |
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