Racial Disparities in End-of-Life Care Among Patients With Prostate Cancer: A Population-Based Study.
Abdollah F, Sammon JD, Majumder K, Reznor G, Gandaglia G, Sood A, Hevelone N, Kibel AS, Nguyen PL, Choueiri TK, Selvaggi KJ, Menon M, and Trinh QD. Racial disparities in end-of-life care among patients with prostate cancer: A population-based study. J Natl Compr Canc Netw 2015; 13(9):1131-1138.
J Natl Compr Canc Netw
OBJECTIVE: To examine racial disparities in end-of-life (EOL) care among black and white patients dying of prostate cancer (PCa).
METHODS: Relying on the SEER-Medicare database, 3789 patients who died of metastatic PCa between 1999 and 2009 were identified. Information was assessed regarding diagnostic care, therapeutic interventions, hospitalizations, intensive care unit (ICU) admissions, and emergency department visits in the last 12 months, 3 months, and 1 month of life. Logistic regression tested the relationship between race and the receipt of diagnostic care, therapeutic interventions, and high-intensity EOL care.
RESULTS: Overall, 729 patients (19.24%) were black. In the 12-months preceding death, laboratory tests (odds ratio [OR], 0.51; 95% CI, 0.36-0.72), prostate-specific antigen test (OR, 0.54; 95% CI, 0.43-0.67), cystourethroscopy (OR, 0.71; 95% CI, 0.56-0.90), imaging procedure (OR, 0.58; 95% CI, 0.41-0.81), hormonal therapy (OR, 0.53; 95% CI, 0.44-0.65), chemotherapy (OR, 0.59; 95% CI, 0.48-0.72), radiotherapy (OR, 0.74; 95% CI, 0.61-0.90), and office visit (OR, 0.38; 95% CI, 0.28-0.50) were less frequent in black versus white patients. Conversely, high-intensity EOL care, such as ICU admission (OR, 1.27; 95% CI, 1.04-1.58), inpatient admission (OR, 1.49; 95% CI, 1.09-2.05), and cardiopulmonary resuscitation (OR, 1.72; 95% CI, 1.40-2.11), was more frequent in black versus white patients. Similar trends for EOL care were observed at 3-month and 1-month end points.
CONCLUSIONS: Although diagnostic and therapeutic interventions are less frequent in black patients with end-stage PCa, the rate of high-intensity and aggressive EOL care is higher in these individuals. These disparities may indicate that race plays an important role in the quality of care for men with end-stage PCa.
Medical Subject Headings
African Americans; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Cardiopulmonary Resuscitation; Clinical Laboratory Techniques; Critical Care; Cystoscopy; European Continental Ancestry Group; Healthcare Disparities; Hospitalization; Humans; Male; Medicare; Office Visits; Prostate-Specific Antigen; Prostatic Neoplasms; Radiotherapy; SEER Program; Terminal Care; Time Factors; United States