Systematic Differences in End-of-Life Care Observed in Centers Serving Minority Patients

High-intensity treatment at end-of-life (EOL) is burdensome and considered low-quality care. Researchers assessed whether minority and white patients receive different quality of EOL care and found that there were systematic differences across U.S. cancer centers.

This retrospective cohort study included Medicare beneficiaries with poor-prognosis cancers who died between April 1, 2016, and December 31, 2016. Researchers attributed patients’ EOL treatment to the cancer center where they received the majority of inpatient services during the last six months of life.

They then adjusted for age, sex, and comorbidities and assessed the following measures of EOL care: chemotherapy regimen, emergency department (ED) use, intensive care unit (ICU) admission, hospice use, life-sustaining treatment use, palliative care, and advance care planning. They compared the findings for minority (black, Hispanic, Asian, other) and non-Hispanic white patients within the same center and across centers. Each center was categorized by the concentration of minorities served: low (<15%), medium (15-30%), and high (>30%).

The study included 126,434 patients, of whom 10,006 (21.4% minority) received treatment at one of 53 National Cancer Institute-designated and/or National Comprehensive Cancer Network-affiliated cancer centers. Only four of eight quality measures had a sufficient sample size to calculate a minority-specific rate for 10 or more centers. The following measures showed high within-center correlation for minority and white patients:

  • ICU admission: P<0.001
  • No hospice referral: P<0.0001
  • Life sustaining treatment: P=0.004
  • Palliative care: P<0.0001.

The mean adjusted rate for minority versus white patients was significantly worse for two measures: no hospice referral (40.2% vs. 37.2%; P<0.02) and life-sustaining treatments (21.8% vs. 19.4%; P<0.02).

When grouped by concentration of minorities served (low, medium, high), five of the eight measures had systematically lower quality as the concentration of minorities increased:

  • More than one ED visit (6.0%, 8.5%, 7.7%; P=0.002)
  • ICU admission (29.1%, 29.7%, 35.1%; P=0.0004)
  • No hospice referral (34.3%, 38.7%, 36.8%; P=0.005)
  • Life-sustaining treatments (14.8% 16.7%, 17.9%; P=0.005)


Wasp G, Alam SS, Brooks GA, et al. Quality of end-of-life cancer care at minority-serving US cancer centers: A retrospective study of Medicare claims data. Abstract #6507. Presented at the 2019 ASCO Annual Meeting, Chicago, IL, May 31, 2019.