Racial-Ethnic Disparities in End-of-Life Care Quality among Lung Cancer Patients: A SEER-Medicare–Based Study

Siddharth Karanth, Suja S. Rajan, Gulshan Sharma, Jose Miguel Yamal, Robert O. Morgan

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Cancer end-of-life care and associated racial-ethnic disparities have been in focus during the last few years due to concerns regarding subjective care variations and poor quality of care. Given the high mortality rate and disease burden of lung cancer, end-of-life care quality is particularly crucial for this disease. This study uses previously validated measures and examines racial-ethnic disparities in lung cancer end-of-life care quality. Methods: This study involves retrospective analysis of patients ≥66 years, who were diagnosed with stage I–IV lung cancer, and who died on or before December 31, 2013, using the Surveillance Epidemiology and End Result-Medicare data from 1991–2013. Poor quality of care was measured using three themes: (1) potentially preventable medical encounters, (2) delayed hospice referral, and (3) aggressive chemotherapy provision during end-of-life. The patients were analyzed as two separate cohorts of NSCLC and SCLC patients. Logistic regression analyses were performed to estimate racial-ethnic disparities in the adjusted odds of receiving poor quality end-of-life care. Results: The study found considerable racial-ethnic disparities in end-of-life care quality. The racial-ethnic minorities had higher odds of experiencing potentially preventable medical encounters in the last month of life as compared with non-Hispanic whites. Odds of delayed hospice referral and aggressive chemotherapy provision during end-of-life were lower in non-Hispanic blacks as compared with non-Hispanic whites. Conclusions: The study findings highlight the continued lack of access and care disparity among the minorities, which could precipitate potentially preventable utilizations, and limit access to hospice care during end-of-life. The study suggests the need to develop educational, patient navigational and other interventions that could potentially reduce aggressive utilizations and improve appropriate hospice care provision during end-of-life.

Original languageEnglish (US)
Pages (from-to)1083-1093
Number of pages11
JournalJournal of Thoracic Oncology
Volume13
Issue number8
DOIs
StatePublished - Aug 1 2018

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Terminal Care
Lung Neoplasms
Quality of Life
Hospice Care
Hospices
Quality of Health Care
Referral and Consultation
Drug Therapy
Medicare
Epidemiology
Retrospective Studies
Logistic Models
Regression Analysis
Mortality
Neoplasms

Keywords

  • Aggressive care
  • End-of-life care
  • Lung cancer
  • Racial-ethnic disparities

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Racial-Ethnic Disparities in End-of-Life Care Quality among Lung Cancer Patients : A SEER-Medicare–Based Study. / Karanth, Siddharth; Rajan, Suja S.; Sharma, Gulshan; Yamal, Jose Miguel; Morgan, Robert O.

In: Journal of Thoracic Oncology, Vol. 13, No. 8, 01.08.2018, p. 1083-1093.

Research output: Contribution to journalArticle

Karanth, Siddharth ; Rajan, Suja S. ; Sharma, Gulshan ; Yamal, Jose Miguel ; Morgan, Robert O. / Racial-Ethnic Disparities in End-of-Life Care Quality among Lung Cancer Patients : A SEER-Medicare–Based Study. In: Journal of Thoracic Oncology. 2018 ; Vol. 13, No. 8. pp. 1083-1093.
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abstract = "Introduction: Cancer end-of-life care and associated racial-ethnic disparities have been in focus during the last few years due to concerns regarding subjective care variations and poor quality of care. Given the high mortality rate and disease burden of lung cancer, end-of-life care quality is particularly crucial for this disease. This study uses previously validated measures and examines racial-ethnic disparities in lung cancer end-of-life care quality. Methods: This study involves retrospective analysis of patients ≥66 years, who were diagnosed with stage I–IV lung cancer, and who died on or before December 31, 2013, using the Surveillance Epidemiology and End Result-Medicare data from 1991–2013. Poor quality of care was measured using three themes: (1) potentially preventable medical encounters, (2) delayed hospice referral, and (3) aggressive chemotherapy provision during end-of-life. The patients were analyzed as two separate cohorts of NSCLC and SCLC patients. Logistic regression analyses were performed to estimate racial-ethnic disparities in the adjusted odds of receiving poor quality end-of-life care. Results: The study found considerable racial-ethnic disparities in end-of-life care quality. The racial-ethnic minorities had higher odds of experiencing potentially preventable medical encounters in the last month of life as compared with non-Hispanic whites. Odds of delayed hospice referral and aggressive chemotherapy provision during end-of-life were lower in non-Hispanic blacks as compared with non-Hispanic whites. Conclusions: The study findings highlight the continued lack of access and care disparity among the minorities, which could precipitate potentially preventable utilizations, and limit access to hospice care during end-of-life. The study suggests the need to develop educational, patient navigational and other interventions that could potentially reduce aggressive utilizations and improve appropriate hospice care provision during end-of-life.",
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AB - Introduction: Cancer end-of-life care and associated racial-ethnic disparities have been in focus during the last few years due to concerns regarding subjective care variations and poor quality of care. Given the high mortality rate and disease burden of lung cancer, end-of-life care quality is particularly crucial for this disease. This study uses previously validated measures and examines racial-ethnic disparities in lung cancer end-of-life care quality. Methods: This study involves retrospective analysis of patients ≥66 years, who were diagnosed with stage I–IV lung cancer, and who died on or before December 31, 2013, using the Surveillance Epidemiology and End Result-Medicare data from 1991–2013. Poor quality of care was measured using three themes: (1) potentially preventable medical encounters, (2) delayed hospice referral, and (3) aggressive chemotherapy provision during end-of-life. The patients were analyzed as two separate cohorts of NSCLC and SCLC patients. Logistic regression analyses were performed to estimate racial-ethnic disparities in the adjusted odds of receiving poor quality end-of-life care. Results: The study found considerable racial-ethnic disparities in end-of-life care quality. The racial-ethnic minorities had higher odds of experiencing potentially preventable medical encounters in the last month of life as compared with non-Hispanic whites. Odds of delayed hospice referral and aggressive chemotherapy provision during end-of-life were lower in non-Hispanic blacks as compared with non-Hispanic whites. Conclusions: The study findings highlight the continued lack of access and care disparity among the minorities, which could precipitate potentially preventable utilizations, and limit access to hospice care during end-of-life. The study suggests the need to develop educational, patient navigational and other interventions that could potentially reduce aggressive utilizations and improve appropriate hospice care provision during end-of-life.

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