2019 ASCO: Differences in End-of-Life Quality Measures Across U.S. Cancer Centers
In a study presented by Wasp et al at the 2019 ASCO Annual Meeting (Abstract 6507) studying variation in end-of-life care across cancer centers in the United States, researchers found quality of care was lower at centers that served a greater concentration of minorities. However, end-of-life care quality for minority and white patients was similar for most measures within any given center.
Study Methods
The researchers aimed to evaluate end-of-life quality outcomes among minority (identified by the authors as black, Hispanic, Asian, and other) and non-Hispanic white patients, as well as to examine whether minority-serving cancer centers had lower end-of-life quality measures. The research team conducted a retrospective cohort study of 126,434 patients with poor-prognosis cancers who had died between April and December 2016 who were also Medicare beneficiaries.
The center where the patient had received the bulk of inpatient services during the last 6 months of life was attributed with that patient's end-of-life care. Researchers examined center-level end-of-life chemotherapy, emergency department use, intensive care unit (ICU) admission, hospice use, life-sustaining treatment use, palliative care, and advance care planning, and then adjusted for age, sex, and comorbidities. They compared measures within the same center and across centers, grouped by the concentration of minority populations served.
Results
The concentration of minority populations served was defined as low (< 15%), medium (15%–30%), or high (> 30%). Approximately 10,000 of the 126,434 patients were defined as being members of a minority group (21.4%), and those patients received treatment at 1 of 53 National Cancer Institute–designated and/or National Comprehensive Cancer Network®–affiliated cancer centers.
Four of the eight total quality measures identified had sufficient sample size to calculate a minority-specific rate for ≥ 10 centers: ICU admission, hospice use, life-sustaining treatment, and palliative care. Those measures showed high within-center correlation for minority and white patients (ICU admission: r = 0.79, P < .001; no hospice referral: r = 0.70, P < .0001; life-sustaining treatment: r = 0.73, P = .004; and palliative care: r = 0.78, P < .0001). However, the mean adjusted rate for minority vs white patients was significantly worse for two measures specifically: no hospice referral (40.2% vs 37.2%) and life-sustaining treatments (21.8% vs 19.4%).
When grouped by the concentration of minorities served (low/medium/high), five of the eight measures showed systematically lower quality as the concentration of minorities increased: more than one emergency department visit (6.0%, 8.5%, and 7.7%; P = .002), ICU admission (29.1%, 29.7%, and 35.1%; P = .0004), no hospice referral (34.3%, 38.7%, and 36.8%; P = .005), and life-sustaining treatments (14.8%, 16.7%, and 17.9%; P = .005).
The researchers concluded, “There were systematic differences in end-of-life quality measures across U.S. cancer centers. For many measures, quality was lower at centers that served a greater concentration of minorities. However, end-of-life care quality for minority and white patients was similar for most but not all measures within any given center.”
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
