In a study reported in the Journal of Clinical Oncology, Rodriguez et al identified racial/ethnic differences in intensity of end-of-life care among patients in California who died from lung cancer between 2005 and 2018.
Study Details
The study used data from the California Cancer Registry linked to patient discharge data abstracts. The primary outcome measure was intensity of care in the last 14 days before death, with greater intensity defined as any hospital admission or emergency department visit, intensive care unit (ICU) admission, intubation, cardiopulmonary resuscitation (CPR), hemodialysis, and death in an acute care setting.
Key Findings
Among 207,429 patients who died from lung cancer from 2005 to 2018, median age was 74 years (range = 18–107); 146,872 (70.8%) were White, 22,325 (10.8%) were Hispanic, 21,697 (10.5%) were Asian/Pacific Islander, and 15,490 (7.5%) were Black. A total of 1,045 (0.5%) were American Indian; due to the small sample size for this group, reliable associations with end-of-life care could not be made.
Compared with White patients:
- Hospital admission was significantly more likely for Black patients (odds ratio [OR] = 1.43, 95% CI = 1.30–1.56), Hispanic patients (OR = 1.27, 95% CI = 1.18–1.36), and Asian/Pacific Islander patients (OR = 1.68, 95% CI = 1.56–1.80)
- Emergency department visits were significantly more likely for Black patients (OR = 1.58, 95% CI = 1.48–1.70) and Hispanic patients (OR = 1.21, 95% CI =1.14–1.28)
- Hospital/emergency department death was significantly more likely for Black patients (OR = 1.24, 95% CI = 1.18–1.31), Hispanic patients (OR = 1.09, 95% CI = 1.04–1.14), and Asian/Pacific Islander patients (OR =1.67, 95% CI = 1.59–1.74)
- ICU admission was significantly more likely for Black patients (OR = 1.49, 95% CI = 1.40–1.58), Hispanic patients (OR = 1.13, 95% CI =1.05–1.18), and Asian/Pacific Islander patients (OR = 1.35, 95% CI =1.24–1.43)
- Intubation was significantly more likely for Black patients (OR = 1.48, 95% CI = 1.40–1.57), Hispanic patients (OR = 1.13, 95% CI = 1.05–1.18), and Asian/Pacific Islander patients (OR =1.31, 95% CI = 1.24–1.38);
- CPR was significantly more likely for Black patients (OR =1.81, 95% CI (1.64–1.99) and Asian/Pacific Islander patients (OR = 1.17, 95% CI = 1.06–1.30)
- Hemodialysis was significantly more likely for Black patients (OR = 2.09, 95% CI =1.81–2.40), Hispanic patients (OR = 1.58, 95% CI = 1.37–1.82), and Asian/Pacific Islander patients (OR = 1.74, 95% CI = 1.52–2.01).
The authors concluded: “Compared with [non-Hispanic White] patients, [Asian/Pacific Islander], Black, and Hispanic patients who died with lung cancer experienced higher intensity of [end-of-life] care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the [end of life].”
Gladys M. Rodriguez, MD, MS, of Northwestern University Feinberg School of Medicine and the Comprehensive Cancer Center, Chicago, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the California Initiative to Advance Precision Medicine. For full disclosures of the study authors, visit ascopubs.org.
