Patients with metastatic cancer who had Medicare or Medicaid and those from racial or ethnic minority groups were more likely to receive low-value, aggressive end-of-life interventions, according to a recent retrospective study. This finding suggests “that identifying and understanding factors associated with the observed disparities will be helpful to inform communications with patients with metastatic cancer about end-of-life care”.
Looking at data from the Healthcare Cost and Utilization Project on 21,335 patients with metastatic cancer, researchers analyzed patterns of care and interventions during terminal hospitalizations. The median age of patients was 65 years and 14.1% of patients were Black, 7.5% were Hispanic, and 3.3% were Asian or Pacific Islander. About half (58.2%) were insured by Medicaid or Medicare.
The majority of patients (63.2%) were admitted to the hospital from the emergency department. Upon admission, 4.6% received systemic therapy and 19.2% received invasive mechanical ventilation.
Patients from racial or ethnic minority groups had increased likelihood of being admitted from the emergency department (Asian/Pacific Islander, odds ratio [OR]=1.43, P<0.001; Black, OR=1.39, P<0.001; Hispanic, OR=1.45, P<0.001). Higher risk was seen for all racial ethnic minority groups for likelihood of receiving invasive mechanical ventilation and incurring higher total charges.
“A higher likelihood of these outcomes was also observed among patients receiving care at urban hospitals, particularly urban teaching hospitals, compared with those receiving care at rural hospitals,” the researchers noted.
In contrast, patients with private insurance had lower odds of being admitted from the emergency department (OR=0.47, P<0.001), receiving invasive mechanical ventilation (OR=0.75, P<0.001), and incurring higher total charges (OR=0.64, P<0.001) compared with patients on Medicare or Medicaid.
“The observed association between measures of high-cost, low-value care and minority race and ethnicity may reflect differences in cultural and environmental factors associated with preferences for end-of-life medical care as well as disparities in the use of palliative and advanced care planning services,” the researchers wrote. “Palliative care discussions and services enhance quality of life for both terminally ill patients and their caregivers and promote goal-concordant care, including the option of an at-home death.”
