Increased Hospice Use Among Minority Patients Treated in Provider-Based Research Networks

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Minority patients with lung cancer who receive treatment in practices affiliated with provider-based research networks “have greater hospice enrollment than those treated in academic and community practices,” concluded Dolly C. Penn, MD, MSCR, and colleagues at the University of North Carolina School of Medicine, Chapel Hill. The researchers found that racial disparities continue to exist throughout the continuum of lung cancer care, but by identifying and implementing techniques used by practices associated with decreasing differences in cancer care for minority patients, “we may improve overall care for minority patients with lung cancer in other practice settings.”

The Community Clinical Oncology Program (CCOP) and Minority-Based Community Clinical Oncology Program (MBCCOP) are provider-based research networks “that improve minority enrollment in cancer-focused clinical trials,” according to the authors. “The CCOP is known for facilitating rapid adoption of advances in cancer therapy. MBCCOPs, differing from CCOPs in having a population that is at least 30% minority or underserved, moderate racial disparity in clinical trial enrollment,” the authors added.

Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, linked to the National Cancer Institute’s CCOP program data, investigators identified patients aged 65 years and older who were diagnosed with primary lung cancer from 2001 to 2007 and died before 2008. In the final cohort of 76,074 patients, 41,885 (55.1%) patients had enrolled in hospice before death.

“Approximately 55% of CCOP, 57% of MBCCOP, 57% of academic, and 52% of community patients enrolled,” the researchers reported. “Asian and black patients in academic (41.1% and 50.4%, respectively) and community practices (35.2% and 43.4%, respectively) were less likely to enroll in hospice compared with white patients (academic, 58.8%; community, 53.1%). However, hospice enrollment was equivalent for black and white patients in MBCCOP [59.5% vs 57.2%] and CCOP [52.2% vs 56.3%] practices,” the investigators noted.

“On multivariable analysis controlling for patient sociodemographic and clinical characteristics, patients who were most likely to use hospice were female [odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.31–1.40], age 79 years and older [OR = 1.11; 95% CI = 1.06–1.16], and white; they also tended to resided in higher education areas and had minimal comorbidities [Charlson comorbidity index = 0], and distant disease at diagnosis,” the study found.

“The finding that the fewer comorbidities patients had the more likely they were to enroll in hospice was surprising,” the researchers stated, and “differed from a previous study showing that hospice patients had more comorbidities than nonhospice patients.” As a possible explanation, the authors proffered that patients with fewer comorbidities could be more concerned with quality of life and enroll in hospice more frequently and sooner to maintain their quality of life and possibly length of survival. ■

Penn DC, et al: J Oncol Pract. April 29, 2014 (early release online).




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