Racial/Ethnic Disparities in End-of-Life Care for Patients With Ovarian Cancer

Key Points

  • In women with ovarian cancer, overall, 72% of patients were enrolled in hospice and 64% died in hospice; compared with white patients, Hispanic and black patients were less likely to enroll and die in hospice.
  • Hispanic patents were more likely to have an ICU admission and black patients were more likely to have > 1 ER visit and to receive a life-extending treatment during the last 30 days of life.

A study using linked Texas Cancer Registry–Medicare data has identified racial/ethnic disparities in end-of-life care in women with ovarian cancer. The study was reported by Taylor et al in the Journal of Clinical Oncology.

Study Details

The study included 3,666 patients dying in 2000 to 2012 who had at least 13 months of continuous Medicare coverage before death. Of these patients, 2,819 (77%) were white, 553 (15%) were Hispanic, 256 (7%) were black, and 38 (1%) were “other.”

End-of-Life Care

A total of 2,642 patients (72%) enrolled in hospice before death and 2,344 (64%) died while enrolled. The median duration of hospice enrollment was 20 days. In the final 30 days of life, 381 (10%) had > 1 emergency room (ER) visit, 505 (14%) had > 1 hospital admission, 593 (16%) had an intensive care unit (ICU) admission, 848 (23%) received invasive care, and 418 (11%) received life-extending care. In the final 14 days of life, 357 (10%) received chemotherapy.

Disparities

In analysis controlling for year of death, age at death, stage, comorbidity index score, educational level, poverty level, and geographic categorization of residence, compared with white patients, Hispanic patients (odds ratio [OR] = 0.78, P = .03) and black patients (OR = 0.74, P = .04) were less likely to enroll in hospice, and Hispanic (OR = 0.76, P = .01) and black patients (OR = 0.66, P = .004) were less likely to die in hospice. Hispanic patients were more likely to have an ICU admission (OR = 1.37, P = .02), and black patients were more likely to have > 1 ER visit (OR = 2.20, P < .001) and receive a life-extending treatment (OR = 2.13, P < .001) within the last 30 days of life.

The investigators concluded: “We found being a minority was associated with receiving intensive and invasive end-of-life care among patients with ovarian cancer.”

The study was supported by grants from Cancer Prevention & Research Institute of Texas, National Institutes of Health, and National Cancer Institute and by the Duncan Family Institute.

Jolyn S. Taylor, MD, MPH, of The University of Texas MD Anderson Cancer Center, 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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