Medical student examines inequity in end-of-life care for patients with metastatic cancer
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A medical student said she looks forward to learning more about oncology and clinical practice after leading a retrospective study that showed racial and ethnic disparities in end-of-life care among patients with metastatic cancer.
Stephanie Deeb, BS, third-year medical student at Icahn School of Medicine at Mount Sinai, and colleagues presented the results during this year’s virtual ASCO Annual Meeting.
“Terminal illness and its medical management can create emotional and financial burdens for patients and caregivers, and it is important to examine care in this setting as a first step to furthering equitable end-of-life care for patients — regardless of social factors,” Deeb told Healio.
As Healio previously reported, Deeb and colleagues retrospectively analyzed interventions performed during 21,335 terminal hospitalizations to determine which patients with metastatic cancer were most likely to receive what they dubbed “futile care.”
Results showed Black, Hispanic and Asian/Pacific Islander patients appeared significantly more likely than non-Hispanic white patients to be admitted from the ED. Black patients also were significantly more likely than non-Hispanic white patients to receive invasive ventilation, with similar trends observed among Hispanic and Asian/Pacific Islander patients.
In addition, patients from racial or ethnic minority groups appeared significantly more likely than non-Hispanic white patients to have total charges significantly higher than the median for the overall cohort.
Deeb spoke with Healio about the importance of this study, her role in the research and whether she sees a career for herself in the field of oncology.
Healio: Why is this study more important today than ever?
Deeb: I have learned from my research mentor, C. Jillian Tsai, MD, PhD, at Memorial Sloan Kettering Cancer Center, as well as professors at Icahn School of Medicine at Mount Sinai, that in medicine it is important to identify areas where patient care could be improved and to evaluate progress in these areas, especially when it comes to patient quality of life.
In line with this emphasis on quality improvement, best practice guidelines have discouraged aggressive care at the end of life among patients with terminal cancer.
Additionally, within the past year, the pandemic has highlighted sociodemographic health disparities and the impacts of social determinants of health on patient outcomes. It is important to consider these factors and potential for improvement across many fields of medicine, including the management of patients with advanced cancer.
Healio: What was unique about this study?
Deeb: Previous studies have reported use of aggressive interventions at the end of life, racial/ethnic disparities in utilization, and associations between aggressive end-of-life care and increased costs and decreased quality of life. This study examined patterns in the use of aggressive inpatient interventions among a sample of patients with metastatic cancer during the past decade and demonstrated disparities based on race/ethnicity and insurance status. It is important to consider existing trends and health care disparities in all areas of medical care, including end-of-life medical management. This can serve as a first step toward assessing and understanding factors that may contribute to these trends and can help identify targetable areas for improved communication, advanced care planning and overall improved quality of life for patients with advanced cancer.
Healio: How did you become involved in this study?
Deeb: I became involved in the study through my medical school research office. We have the opportunity to complete a research project during our first 2 years of medical school. The research office helps to connect us with mentors who can oversee a project in a field of interest, and I was able to connect with Dr. Tsai through this program. She discussed her research interests with me and designed this study incorporating my interests and goals. As for my role in the study, I worked with the National Inpatient Sample data set to carry out analysis, as well as literature review and synthesis of our findings. I worked closely with Dr. Tsai throughout the entire process to verify our analysis, results and conclusions.
Healio: Are you planning to specialize in oncology?
Deeb: I am interested in oncology and am grateful for the opportunity to learn more about this specialty from Dr. Tsai and others involved with the Health Outcomes, Policy and Epidemiology (HOPE) research group at Memorial Sloan Kettering Cancer Center. I appreciate their encouragement and the time they have spent teaching and mentoring me, and I look forward to continuing to study more about oncology during clerkships. I am excited to learn more about the clinical practice after being involved in research.
Healio: How have your mentors influenced you along the way?
Deeb: I have been very lucky to have wonderful research mentors both in my undergraduate program and in medical school. Dr. Tsai has been a wonderful mentor; working on this project with her has been very rewarding and educational. She has taught me about many aspects of the research process, including study design, analysis and statistics. Dr. Tsai and her colleagues who contributed to this project as a part of the HOPE research group have been extremely supportive and have pushed me to develop skills in analysis and writing. Their guidance has been an encouraging and positive influence in my medical school experience. I am also grateful for the funding and support from Memorial Sloan Kettering Cancer Center and for the support of the Medical Student Research Office at Icahn School of Medicine at Mount Sinai.
For more information:
Stephanie Deeb, BS, can be reached at stephanie.deeb@icahn.mssm.edu.
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