Racial, ethnic minorities less likely to receive palliative care during cancer treatment
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Key takeaways:
- Palliative care use increased between 2004 and 2020.
- Compared with white patients, the use of palliative care appeared lowest among racial and ethnic minorities.
Palliative care use remained significantly low between 2004 and 2020 among certain racial and ethnic minority patients with metastatic breast cancer, according to study results.
The findings — presented during the American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved — indicate a need for improving access to and use of palliative care services among certain historically underserved patient populations.
Rationale and methods
National Comprehensive Cancer Network guidelines for palliative care recommend all patients with cancer be screened to determine their palliative care needs, both at intake and throughout treatment, according to background information provided by the AACR.
“Palliative care is under-researched and there is a paucity of data on the trends in the usage of palliative care among patients with metastatic breast cancer,” Jincong Freeman, MPH, MS, doctoral student in the department of public health sciences at University of Chicago, told Healio. “Previous study findings of racial and ethnic disparities in palliative care use are also inconsistent and focused largely on Black patients vs. white patients and — to a lesser extent — Hispanic patients. We wanted to examine other additional racial and ethnic groups with metastatic breast cancer.”
Researchers sought to assess how palliative care use in the U.S. changed over time for patients with metastatic breast cancer and to evaluate differences in use between different racial and ethnic groups to better understand potential disparities.
They examined data from the National Cancer Database and collected records from between 2004 and 2020 that included 148,931 patients (mean age, 62.3 years; 72.4% white, 16.9% Black, 5.9% Hispanic, 3% Asian/Pacific Islander, 1.18% American Indian/Alaska Native/other) with newly diagnosed metastatic breast cancer.
Findings
Results showed that palliative care use significantly increased from 14.9% in 2004 to 27.6% in 2020.
“However, palliative care use remained suboptimal, as more than 70% of patients had not received any palliative care service,” Freeman said.
After adjusting for clinical and sociodemographic factors, researchers identified 13% lower likelihood for palliative care use among Black patients, 26% lower use among Asian/Pacific Islander and 35% lower use among Hispanic patients vs. white patients.
Of note, investigators observed no significant differences in palliative care use among white patients and those who identified as American Indian, Alaska Native or other.
Researchers acknowledged multiple study limitations, including the potential for underreporting or misclassifications of palliative care in the National Cancer Database. Additionally, the researchers did not have information on patients’ symptoms or treatment side effects, which could determine whether palliative care is necessary.
Implications
The findings underscore the importance of promoting the benefits of palliative care and addressing racial and ethnic disparities to improve quality of life for patients with metastatic breast cancer, Freeman told Healio.
“Given the benefits of early palliative care intervention and current ASCO and NCCN recommendations, it is essential to identify the needs of this patient population — particularly racial and ethnic minority patients — and evaluate how oncology programs can integrate palliative care early into the cancer care continuum while ensuring equitable access to palliative and other supportive care,” he said.
Freeman said he and colleagues are currently investigating the survival of patients with metastatic breast cancer who have received palliative care.
“The National Cancer Database collects information on OS, but differential rates of OS across racial and ethnic groups of patients who have used palliative care remain unknown,” he said. “We want to know whether racial and ethnic survival disparities persist in this patient cohort, as the findings may help improve patients’ quality of life and potentially prolong survival.”
References:
- Freeman J, et al. Trends and racial/ethnic disparities in palliative care use among patients with de novo metastatic breast cancer – National Cancer Database, 2004-2020. Presented at: AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 29-Oct. 2, 2023; Orlando.
- Racial/ethnic minority patients may be less likely than white patients to receive palliative care during breast cancer treatment (press release). Available at: https://www.aacr.org/about-the-aacr/newsroom/news-releases/racial-ethnic-minority-patients-may-be-less-likely-than-white-patients-to-receive-palliative-care-during-breast-cancer-treatment/. Published Sept. 29, 2023. Accessed Sept. 29, 2023.
Perspective
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Kimberlee S. Fong, DO
Studies have shown that palliative care and hospice improve quality of life, improve symptom and pain management, and contribute to establishing patient-centered goals of care among people with serious illnesses. Despite this, palliative and hospice care are underutilized among people of color and individuals from underrepresented minority groups.Therefore, the authors’ findings that the use of palliative care appeared lowest among racial and ethnic minorities is not surprising. There are multiple studies that imply palliative care at end of life is less utilized by those from racial or ethnic minority groups. They are less likely to participate in advanced care planning, have decreased enrollment in hospice and are more likely to die in a hospital. Why is this important? Because we know — although most people die in a hospital setting — surveys reveal when given the option, a majority of people would prefer to die at home. If discussions around advanced care planning do not occur, the wishes of patients are not known and are unlikely to be followed.
The reasons for disparities are complex, and a key first step would be to identify barriers for access and enrollment in palliative care from the patient’s point of view. There are underlying concerns for mistrust from patients and families due to past historical and even current experiences. At Cleveland Clinic, we are working toward first identifying patients correctly so that proper resources are available, and data can be collected in a more precise standardized manner. Organizations such as Center to Advance Palliative Care and American Academy of Hospice and Palliative medicine also provide resources to health care workers to improve education and outreach.
We know there are facets of disparities in all medical fields, not just palliative care. So, what can we do? We as a group need to start with our hearts and continue with empathy so that we can provide the best care for all our patients. Each person, along with their family, has a journey. It is not for us to determine their journey, but rather to help alleviate symptoms and burdens along their way.
References:
Weitzen S, et al. Med Care. 2003;doi:10.1097/01.MLR.0000044913.37084.27.
Wicher CP, et al. J Health Care Poor Underserved. 2012;10.1353/hpu.2012.0027.
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Freeman J, et al. Trends and racial/ethnic disparities in palliative care use among patients with de novo metastatic breast cancer – National Cancer Database, 2004-2020. Presented at: AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 29-Oct. 2, 2023; Orlando.
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