Hospital death less likely, hospice more likely for white women with ovarian cancer

Key takeaways:

• Black, American Indian, Asian and Hispanic women with ovarian cancer had higher in-hospital mortality odds vs. white women.
• Women from underrepresented groups had lower hospice mortality odds vs. white women.

Women with ovarian cancer from underrepresented groups have a higher likelihood of in-hospital mortality vs. hospice mortality compared with their white counterparts, according to study results published in Obstetrics & Gynecology.

“Location of death can influence the quality of end-of-life care, like ability to effectively treat symptoms and provide emotional support to the patient and their family. This work underscores the importance of initiatives to improve communication with patients and families about end-of-life options,” Angelin T. Mathew, BS, a student at Yale University, told Healio. “As patients with ovarian cancer can have prolonged treatment courses and significant symptom burden, improving care at the end-of-life is an important goal.”

Utilizing the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) database, Mathew and colleagues evaluated data from 237,069 U.S. women with ovarian malignancy as their primary cause of death from 2003 to 2019. Researchers assessed associations between patient characteristics and location of death, including hospital, home, nursing facility, hospice facility and outpatient medical facility or ED.

From 2003 to 2019, the proportion of home and hospice mortality increased and in-hospital, nursing home and outpatient medical facility or ED mortality decreased.

Black (adjusted OR = 1.69; 95% CI, 1.63-1.74), American Indian (aOR = 1.47; 95% CI, 1.3-1.66) and Asian (aOR = 1.54; 95% CI, 1.46-1.62) women with ovarian cancer had higher likelihoods of in-hospital mortality compared with white counterparts (P < .001 for all). In addition, Black (aOR = 0.93; 95% CI, 0.89-0.98), American Indian (aOR = 0.57; 95% CI, 0.45-0.72) and Asian (aOR = 0.66; 95% CI, 0.6-0.72) women with ovarian cancer had lower odds of hospice mortality compared with white counterparts (P < .001 for all).

Researchers also observed a higher likelihood of in-hospital mortality (aOR = 1.24; 95% CI, 1.19-1.28) and a lower likelihood of hospice mortality (aOR = 0.93; 95% CI, 0.88-0.98) among Hispanic women with ovarian cancer compared with non-Hispanic women (P < .001 for both).

Regarding education, women with a college education had higher odds of mortality at home (aOR = 1.09; 95% CI ,1.08-1.12) and in hospice (aOR = 1.18; 95% CI, 1.15-1.21) mortality compared with women without a college education (P < . 001 for all). Women with a college education also had lower odds of in-hospital (aOR = 0.9; 95% CI, 0.88-0.92) and nursing facility (aOR = 0.83; 95% CI, 0.8-0.85) mortality compared with women without a college education (P < . 001 for all).

According to Mathew, there are few resources for culturally sensitive end-of-life care and racial/ethnic minority patients with ovarian cancer may benefit from this type of care, communication and advanced care planning.

“We’re interested in a variety of related questions that could provide information on how racial/ethnic gaps can be overcome when delivering high-quality end-of-life care,” Mathew said. “For example, we like to better understand how socioeconomic, rurality and insurance status influences place of death and how intersectionality drives patient decision-making and/or communication. This type of information is important to improving both patient education and provider training.”

For more information:

Angelin T. Mathew, BS, can be reached at angelin.mathew@yale.edu.