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2019 Supportive Care: Racial Disparities in Use of Hospice Care Near Death Among Patients With Pancreatic Cancer


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A study investigating the utilization of hospice care among racial/ethnic minority patients following treatment for pancreatic cancer has found that African American and Hispanic patients who underwent surgical removal of the pancreas were less likely than white patients to use hospice services at the end of life. However, all groups were just as likely to use hospice late, meaning initiation within 3 days of death. Further research is needed to better understand the potential barriers to the initiation of hospice care among racial/ethnic minority patients with cancer at the end of life, concluded the study authors. The study by Paredes et al will be presented at the 2019 Supportive Care in Oncology Symposium (Abstract 41).

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Despite advances in the detection and management of pancreatic cancer, the disease remains difficult to treat and is among the deadliest of all cancers. About 56,770 men and women will be diagnosed with pancreatic cancer in 2019, with African American patients being disproportionately affected by the disease. For decades, the incidence rate of pancreatic cancer among African Americans has been 30% to 70% higher than other racial groups in the United States, and the 5-year survival rate is lower—5% vs 9%, respectively.

Study Methodology

The researchers used the Medicare Standard Analyticak Files to identify 14,495 white and racial/ethnic minority patients (13,515 vs 980, respectively) who had undergone pancreatectomy for pancreatic cancer. They then analyzed the trends and timing related to overall hospice utilization among these patients. All the patients had equal insurance coverage through Medicare Parts A and B and had no additional coverage through other insurers. The median age of the patients was 73 years old.

The researchers then analyzed the records of 6,859 patients (47%) who were deceased by the end of the follow-up period (December 31, 2017).

KEY POINTS

  • Although most patients undergoing pancreatectomy for pancreatic cancer were likely to initiate hospice care within 3 days of death, African American and Hispanic patients were 22% less likely to use hospice care than white patients.
  • Oncology providers should incorporate palliative care services into oncology care early in the treatment process to ensure patients’ best quality of life at the end of life, said the authors.

Results

The researchers found that despite similarities in sex, age, comorbidities, and insurance status, African American and Hispanic patients were 22% less likely to use hospice care than their white counterparts—67% vs 73%, respectively. Of the patients in this group, only 4,978 (72.6%) used hospice services at the time of death, and minority and white patients were just as likely to initiate hospice care late, within 3 days of death.

“While most patients undergoing pancreatectomy for pancreatic cancer utilized hospice services prior to death, ethnic/racial minority [patients] were less likely to use hospice services than whites. Further research should seek to better understand possible barriers to hospice initiation among racial/ethnic minority patients with cancer,” concluded the study authors.

Clinical Relevance

“Hospice and palliative care are not just the responsibility of medical oncologists,” said first study author Anghela Paredes, MD, MS, a surgical resident at The Ohio State University Wexner Medical Center, in a statement. “All cancer care providers need to incorporate [palliative care] into the treatment strategy early on. We need to be comfortable discussing our patients’ end-of-life goals and exploring what services could help them ensure their best quality of life at the end of life.”

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®.
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