Could Site of Care Affect Palliative Care in Minority Cancer Patients?

A recent study found that treatment receipt at minority-serving hospitals (MSHs) was associated with lower use of palliative care among racial and ethnic minority metastatic cancer patients.

For the retrospective cohort study, published in JAMA Network Open, researchers queried the Participant Use Files of the National Cancer Database (NCDB) for data on patients aged older than 40 years with metastatic prostate, lung, colon, and breast cancer who were diagnosed from Jan. 1, 2004, through Dec. 31, 2015. MSHs were defined as hospitals in the top decile for the proportion of black and Hispanic patients for each cancer type.

Final analysis included 601,680 patients (mean age, 67.4 years; 52.2% male; 78.9% white). Overall, 130,813 patients (21.7%) received palliative care, with differences observed by cancer type: 15.3% of metastatic prostate cancer patients, 25.4% of metastatic lung cancer patients, 11.1% of metastatic colon cancer patients, and 18.5% of metastatic breast cancer patients received palliative care. When broken down by race, 22.5% of white patients, 20% of black patients, and 15.9% of Hispanic patients received palliative care (P < 0.001 for all). Regardless of race, MSH patients were less likely than non-MSH patients to receive palliative care (18% vs. 22.3%, P = 0.002). An adjusted analysis found that MSH patients had significantly reduced odds of receiving palliative care compared to non-MSH patients (odds ratio, 0.67; 95% CI, 0.53-0.84).

Previous studies have found that racial minorities tend to receive worse care and have worse outcomes when it comes to health care. Particularly for minority cancer patients, screening, treatment, survival, and end-of-life care disparities exist, the researchers point out.

One of the study’s limitations was the use of the NCDB for data collection. The study also only examined four types of cancer.

The Importance of Palliative Care in Cancer Treatment

Palliative care is important for treating advanced cancer, the study authors note. Cancer is the United States’ second leading cause of death, and metastatic cancer patients frequently die from their disease. Palliative care may improve their quality of life and even extend their life.

Palliative care not only benefits the patient but also could be beneficial for their caregiver, according to the National Cancer Institute: “It’s common for family members to become overwhelmed by the extra responsibilities placed upon them. Many find it hard to care for a sick relative while trying to handle other obligations, such as work, household duties, and caring for other family members. Uncertainty about how to help their loved one with medical situations, inadequate social support, and emotions such as worry and fear can also add to caregiver stress.”

Other issues addressed by palliative care include:

• Physical. Palliative care addresses symptoms and side effects associated with the disease and treatment, such as fatigue, pain, appetite loss, nausea, vomiting, shortness of breath, and insomnia
• Emotional and coping. This includes depression, anxiety, and fear.
• Practical needs. Financial and legal issues may also be addressed through palliative care.
• Spiritual.

In the present study, the researchers found that MSHs, not minority race/ethnicity, were associated with reduced odds of receiving palliative care. “Strategies that focus on improving palliative care use at MSHs may be an effective strategy to increase the receipt of palliative care for this population,” they concluded.

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Source: JAMA Network Open