End-of-life Care in Ovarian Cancer Remains Aggressive—Especially for Women of Color

Contrary to clinical guidelines, women with ovarian cancer continue to receive aggressive end-of-life care, with non-white women disproportionately affected, according to a study.

“Although the early integration of palliative care and the reduction of intensive and invasive end-of-life care have been included more and more in guidelines, these recommendations are not making enough of a difference in the type of care people with ovarian cancer receive at the end of their lives, especially for people of color,” said first study author Megan Mullins, PhD, MPH, in a press release.

Dr. Mullins and her coauthors assessed data on more than 7,700 Medicare beneficiaries with ovarian cancer who died from 2007 through 2016. They looked at information such as hospice use, multiple emergency department (ED) visits, intensive care unit (ICU) admission, invasive procedures, and more, examining trends and racial disparities.

During the last month of life, the women were much more likely to be admitted to the ICU and have multiple ED visits, and much less likely to not enroll in hospice at the end of life and have terminal hospitalizations.

Outcomes differed by race, the researchers observed: hospital-related utilization and life-extending procedures were much more common in non-white women, and non-Hispanic Black women had much higher odds of having multiple ED visits and undergoing life-extending procedures than non-Hispanic white women.

The American Society of Clinical Oncology recommends that patients with advanced cancer be given dedicated palliative care early on in their disease, and it should be given along with active treatment. Palliative care should include building rapport among patients and family caregivers and providers, managing symptoms, discussing treatment goals, communication among care providers, and more.

“Prognostication is difficult,” according to Dr. Mullins. “But being honest about the risks and benefits of treatment is important. Engaging in conversations with patients about the goals of their care allows them to consider how they would like to spend the time they have left.”

The study was published in Cancer.