People with metastatic cancer treated at hospitals that primarily serve minorities are less likely to receive palliative care than those attending majority white-serving hospitals.
Cancer is the second leading cause of death in the US, and most people with metastatic disease will die from the condition. Palliative care can prolong survival as well as improve quality of life for these patients.
There are wide health disparities surrounding cancer screening, treatment and survival in the US, with people from black and ethnic minorities receiving worse care and poorer outcomes. Differences in the level of end-of-life care that minority patients receive when compared to their white counterparts have also been highlighted.
Previous studies aimed at finding the reason for this have looked at patient characteristics and physician bias. This study, however, looked at the role of site of care.
“Because hospital care for most minority patients is concentrated at a comparatively small number of facilities, differences in care at these minority-serving hospitals (MSHs) could explain worse population-level outcomes for minorities overall,” the authors explain.
Using data from the Participant Use Files of the National Cancer Database (NCDB), researchers assessed the racial and ethnic differences of patients receiving palliative care after a diagnosis of metastatic prostate, lung, colon or breast cancer. The records of more than 600,000 people were used.
Palliative care was defined as pain control, surgical treatment, radiation therapy and systemic chemotherapy administered to alleviate symptoms rather than to treat the disease.
The proportion of black or Hispanic patients treated at each hospital was calculated. Those with the greatest proportion were considered “minority serving hospitals” (MSH), and those that were not in the top 10% were “non-minority serving hospitals” (non-MSH).
Overall, of the more than 600,000 records analyzed, 21.7% received palliative care.
A total of 106,603, or 22.5%, of white patients received palliative care. This compared to 20% of the 16,435 black patients and 15.9% of the 3,551 Hispanic patients.
Patients treated at an MSH had just two-thirds the odds of receiving palliative care when compared with patients cared for at a non-MSH. This finding was irrespective of the patient’s race or ethnicity.
The policy implications of this finding are significant, say the authors, pointing out that care for minority patients in the US is concentrated at a relatively small number of hospitals.
“If initiatives to target palliative care-use at MSHs are successful, national disparities in palliative care may be reduced,” they add.
The findings fit with an increasing understanding that health outcomes for patients from minority communities are impacted by where they receive care.
“More than being a function of individual behavior, there is increasing recognition that disparities in outcomes depend on different treatment of white and minority patients within the same hospital and systemic differences in where minority patients receive care,” says the study.
Cole AP, Nguyen DD, Meirkhanov A, Golshan M, Melnitchouk N, et al. Association of Care at Minority-Serving vs Non-Minority-Serving Hospitals With Use of Palliative Care Among Racial/Ethnic Minorities With Metastatic Cancer in the United States. JAMA Netw Open 2019; 2:e187633.