African Americans, Hispanics less likely than whites to use hospice for pancreatic cancer
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African American and Hispanic patients who underwent pancreatectomy for pancreatic cancer appeared less likely than their white counterparts to utilize hospice services more than 3 days before death, according to results of a retrospective study scheduled for presentation at Supportive Care in Oncology Symposium.
“Though barriers to hospice care exist among racial and ethnic minorities, when assessed, hospice services have the potential to facilitate the end of life patients envision,” Anghela Z. Paredes, MD, MS, surgical resident at The Ohio State University Comprehensive Cancer Center, said in a press release. “For patients with life-limiting illnesses, planning or integrating hospice earlier may provide them an opportunity to think about goals and desires for their remaining days and helps them design a care plan that they are more comfortable with.”
Previous studies have shown ethnic and racial disparities in treatment of pancreatic cancer, incidence of which is 25% higher among African Americans than among whites. However, these studies did not explore possible differences in hospice utilization.
Paredes and colleagues used Medicare claims data to analyze racial and ethnic trends in use and timing of hospice care among 6,530 patients (median age, 73 years; interquartile range, 69-78; 51.5% women; 6.6% African American or Hispanic) with pancreatic cancer who underwent a pancreatectomy.
Among all patients, 4,221 (64.6%) died during the follow-up period, and 3,149 (74.6%) of them used hospice services before death.
Results showed African Americans and Hispanics appeared significantly less likely to use hospice care than white patients (68.9%, n = 188 vs. 75%, n = 2,961; P = .024).
A multivariate analysis controlling for factors such as sex, age, comorbidities and insurance status confirmed the lower likelihood of overall hospice use among African Americans and Hispanics (OR = 0.73; 95% CI, 0.56-0.95). However, African Americans and Hispanics had comparable odds to white patients of hospice use within 3 days of death (OR = 0.75; 95% CI, 0.49-1.14).
Paredes noted that although the ideal timing of hospice initiation has not been clearly defined, late hospice use has been associated with receipt of life-sustaining measures and greater Medicare costs.
“Hospice and palliative care are not just the responsibility of medical oncologists,” Paredes said. “All cancer care providers need to incorporate hospice 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.” – by John DeRosier
Reference:
Paredes AZ, et al. Abstract 41. Scheduled for presentation at: Supportive Care in Oncology Symposium; Oct. 24-25, 2019; San Francisco.
Disclosures: Paredes reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.
Perspective
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Edo Banach, JD
Everyone will die eventually. We all have that in common. With a life-ending illness, we have the choice of hospice care. All of us deserve that choice.
However, a growing body of research suggests non-white Americans are much less likely than their white counterparts to enter hospice care. Even when controlling for socioeconomic factors such as income, age and education, there is a significant racial and ethnic disparity when it comes to hospice utilization.
Decades of experience show that hospice care offers patients and their families many benefits during an extremely emotional and vulnerable time. Given these benefits — which include ensuring comfort, convenient home care, social and spiritual support — it’s little wonder that more than half of Medicare beneficiaries choose to take advantage of hospice care before passing away.
These benefits know no single race, ethnicity, national origin or language. They can be universally enjoyed by all. Yet, disparities still exist due to barriers to access, cultural differences and lack of understanding.
A study published in Journal of Pain and Symptom Management showed 84% of Hispanics in Queens County, N.Y., said they have never heard of hospice, and similar trends hold for members of other minority groups. Without knowing what options are available, it is impossible for patients to make informed choices when it comes to end-of-life care. When asked if they would like to learn more about hospice care, an overwhelming majority of individuals in underserved communities said yes; 95% of Hispanics and 94% of Chinese speakers were open to exploring the hospice option if they had more knowledge about it.
By not electing hospice, communities of color are not only missing out on improved quality of life and compassionate care, but they also are spending more health care dollars. Minorities are much more willing than whites to pay significant sums for life-sustaining treatments instead of hospice. This is perhaps why Medicare spends about 20% more on the last year of life for black and Hispanic individuals than white individuals. Increasing access to hospice in minority communities could save Medicare more than $2,100 per enrollee — equal to about $270 million in annual savings. Higher hospice utilization for the U.S. as a whole is estimated to generate savings between $2,309 to $17,903 per hospice user — up to $2 billion per year.
Medicare savings are one thing, but not having the experience of hospice care because the patient and family members have not been informed is another. That has to change.
To close the gap, the path forward is clear: We must expand access to — and knowledge of — hospice care. Fortunately, many in Congress agree. The bipartisan Rural Access to Hospice Act (S. 1190/H.R. 2594) will remove a significant access barrier among underserved patient populations by empowering patients served by rural health clinics and federally qualified health centers (FQHCs) to keep their physician of choice when electing hospice care. FQHCs serve a higher proportion of racial and ethnic minorities, meaning historically underserved communities can have greater access to hospice. If enacted, the bill would allow millions more Americans to choose hospice care so patients and families can experience more peaceful and meaningful time together.
There should be no barriers to that choice.
References:
Hughes MC and Vernon E. Gerontol Geriatr Med. 2019;doi:10.1177/2333721419855667.
Martin MY, et al. Cancer. 2011;doi:10.1002/cncr.25839.
Nath JB, et al. JAMA Intern Med. 2016;doi:10.1001/jamainternmed.2016.0705.
Pan CX, et al. J Pain Symptom Manage. 2015;doi:10.1016/j.jpainsymman.2014.09.016.
The National Hospice and Palliative Care Organization. Hospice: Leading Interdisciplinary Care. Available at: www.nhpco.org/wp-content/uploads/2019/05/hospice_policy_brief.pdf.
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