|The following article features coverage from the American Society of Clinical Oncology 2019 meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
The quality of end-of-life cancer care at cancer centers serving minority patients — defined by researchers as patients who were black, Hispanic, Asian, or “other” — decreased as the concentrations of these populations seen at the centers increased, according to the results of a study presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting.
By retrospectively analyzing Medicare claims data of 126,434 patients with poor-prognosis cancers who received inpatient services at 1 of the 53 cancer hubs with either a National Cancer Institute (NCI) designation or an affiliation with the National Comprehensive Cancer Network (NCCN) between April 2, 2016, and December 31, 2016, researchers determined that the factors necessary for quality care at the end of life (EOL), including the receipt of chemotherapy, use of emergency department services, and admission to the intensive care unit, as well as the use of hospice care, life-sustaining treatments, palliative care, and EOL care planning, were found to be similar to those of non-Hispanic white individuals when looking only at patients treated at a single institution.
But when the investigators examined populations across different cancer centers, the quality of care given to minority patients compared with non-minority individuals appeared to be quite different. These differences in care were most prominent when centers with a high proportion of minority patients (more than 30% of all patients) were compared with the quality outcomes of white patients.
The mean-adjusted rates of 8 quality measures for minority patients were examined alongside the rates in white patients, which led to the discovery that the rates of hospice referral (40.2% vs 37.2%, respectively; P <.02) and of the receipt of life-sustaining therapies (21.8% vs 19.4%, respectively; P <.02) were significantly worse at centers that treated a higher number of minority patients.
When centers with low (< 15%), medium (15%-30%), or high concentrations of minority patients were compared, the centers with higher numbers of these patients were found to have systematically lower levels of EOL quality outcomes across 5 of the 8 measures.
Immediately following the presentation, Erica T. Warner, ScD, MPH, assistant professor of medicine at Harvard Medical School and the Massachusetts General Hospital in Boston, commented on the findings. She said that focusing on only NCCN and NCI was an overly narrow focus that represented fewer than 8% of all Medicare decedents.
Similarly, pooling “minorities” together in a single group is troublesome, she noted, and should be considered a study limitation. Ultimately, health care segregation is bad for everyone, Dr Turner asserted. “Improving palliative care quality at minority-serving cancer centers could improve the health of minority and white patients treated there and reduce racial disparities in palliative care.”
Wasp G, Alam SS, Brooks, GA, et al. Quality of end-of-life cancer care at minority-serving US cancer centers: A retrospective study of Medicare claims data. Presented at: 2019 Annual American Society of Clinical Oncology meeting; Chicago, IL; May 31-June 4, 2019. Abstract 6507.
This article originally appeared on Cancer Therapy Advisor