Race and Medicine
Race and Medicine
Perspective from Edo Banach, JD
October 23, 2019
2 min read
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African Americans, Hispanics less likely than whites to use hospice for pancreatic cancer

Perspective from Edo Banach, JD
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African American and Hispanic patients who underwent pancreatectomy for pancreatic cancer appeared less likely than their white counterparts to utilize hospice services more than 3 days before death, according to results of a retrospective study scheduled for presentation at Supportive Care in Oncology Symposium.

“Though barriers to hospice care exist among racial and ethnic minorities, when assessed, hospice services have the potential to facilitate the end of life patients envision,” Anghela Z. Paredes, MD, MS, surgical resident at The Ohio State University Comprehensive Cancer Center, said in a press release. “For patients with life-limiting illnesses, planning or integrating hospice earlier may provide them an opportunity to think about goals and desires for their remaining days and helps them design a care plan that they are more comfortable with.”

Previous studies have shown ethnic and racial disparities in treatment of pancreatic cancer, incidence of which is 25% higher among African Americans than among whites. However, these studies did not explore possible differences in hospice utilization.

Paredes and colleagues used Medicare claims data to analyze racial and ethnic trends in use and timing of hospice care among 6,530 patients (median age, 73 years; interquartile range, 69-78; 51.5% women; 6.6% African American or Hispanic) with pancreatic cancer who underwent a pancreatectomy.

Among all patients, 4,221 (64.6%) died during the follow-up period, and 3,149 (74.6%) of them used hospice services before death.

Results showed African Americans and Hispanics appeared significantly less likely to use hospice care than white patients (68.9%, n = 188 vs. 75%, n = 2,961; P = .024).

A multivariate analysis controlling for factors such as sex, age, comorbidities and insurance status confirmed the lower likelihood of overall hospice use among African Americans and Hispanics (OR = 0.73; 95% CI, 0.56-0.95). However, African Americans and Hispanics had comparable odds to white patients of hospice use within 3 days of death (OR = 0.75; 95% CI, 0.49-1.14).

Paredes noted that although the ideal timing of hospice initiation has not been clearly defined, late hospice use has been associated with receipt of life-sustaining measures and greater Medicare costs.

Hospice and palliative care are not just the responsibility of medical oncologists,” Paredes said. “All cancer care providers need to incorporate hospice into the treatment strategy early on. We need to be comfortable discussing our patients’ end-of-life goals and exploring what services could help them ensure their best quality of life at the end of life.” – by John DeRosier

Reference:

Paredes AZ, et al. Abstract 41. Scheduled for presentation at: Supportive Care in Oncology Symposium; Oct. 24-25, 2019; San Francisco.

Disclosures: Paredes reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.