Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Patients With Stage IV Breast Cancer

Key Points

  • Black women were less likely than white women to receive nonopioid psychotropic medications within 90 days of diagnosis of stage IV breast cancer.
  • Black women were less likely than white women to use hospice and more likely to die in the hospital.

In a study reported in the Journal of Clinical Oncology, Check et al identified disparities in supportive medication use and end-of-life care between black and white Medicare patients with stage IV breast cancer.

Study Details

The study involved SEER (Surveillance, Epidemiology, and End Results)–Medicare data on 752 white and 131 black women with stage IV breast cancer who died between 2007 and 2012. Use of supportive medications within 90 days of diagnosis was examined; supportive medications consisted of opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids.

Disparities

Black women were less likely than white women to receive nonopioid psychotropic medications (adjusted risk ratio [aRR] = 0.51, 95% confidence interval [CI] = 0.35–0.74) but not opioid pain medication. Black women were less likely than white women to use hospice (aRR = 0.86, 95% CI = 0.74–0.99), more likely to have intensive care unit admission or at least one emergency department visit or hospitalization 30 days before death (aRR = 1.28, 95% CI = 1.01–1.63), and more likely to die in the hospital (aRR = 1.59, 95% CI = 1.22–2.09). Use of nonopioid psychotropic medications was not significantly associated with hospice use, dying in the hospital, or health care use in the last 30 days of life overall or by racial group.

The investigators concluded: “We observed racial disparities in early supportive medication use among patients with stage IV breast cancer. Although they did not clearly attenuate end-of-life care disparities, medication use disparities may be of concern if they point to disparities in adequacy of symptom management given the potential implications for quality of life.”

The study was supported by the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 Program and the North Carolina Translational and Clinical Sciences Institute.

Devon K. Check, PhD, of the University of North Carolina at Chapel Hill, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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