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 Researchers examined data from Medicare, the U.S. government health
program for the elderly, for 752 white and 131 black patients with
final-stage breast cancer who died from 2007 to 2012.
Black women were 49 percent less likely to receive certain
medications for symptom relief than white patients, and they were
also 14 percent less likely to get hospice care aimed at improving
quality of life in their final days, the study found.
At the same time, black women were 28 percent more likely than white
women to have emergency department visits or hospitalizations in
their last month of life, and they were also 59 percent more likely
to die in the hospital.
"Unfortunately, we found potential disparities in the use of
supportive medications for treatment of common symptoms of cancer,
namely, depression, anxiety, and insomnia," said lead study author
Devon Check, a public health researcher at the University of North
Carolina, Chapel Hill.
To assess racial disparities in end-of-life breast cancer care,
Check and colleagues focused on the drugs women received in the
three months after their diagnosis as well as the types of medical
treatment they had in their final month of life.
Their hypothesis was that differences in the types of medical
treatments women received at the end of life might be influenced by
the number of medications women initially received.
Even though the study didn't find a relationship between these two
aspects of cancer care, black women's lack of access to supportive
medications relative to white women still points to disparities that
need to be addressed, Check said by email.
"Disparities in supportive medication use are concerning as they
could point to inadequate symptom management and reduced quality of
life," Check said. "It is important for patients and providers to
communicate about supportive care needs and preferences – for
example, surrounding symptoms of anxiety, depression, insomnia and
pain – to alleviate patient distress and suffering."
Black women in the study tended to have more diseases in addition to
cancer than the white women, and they were also more likely to be
single and have a lower socioeconomic status.
The women ranged in age from 65 years old into their 80s, but a
larger proportion of the black women were on the younger end of this
spectrum. One third of black women were diagnosed between ages 65
and 70, while 30 percent of white women were diagnosed at age 83 or
older.
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All of the women had similar patterns of cancer therapy and
comparable use of powerful opiate painkillers, researchers report in
the Journal of Clinical Oncology.
But just 13 percent of black women got psychotropic drugs designed
to improve their mood and ease anxiety, compared with 23 percent of
white women.
One limitation of the study is that it focused only on women with
what's known as fee-for-service Medicare, which might influence
their cost and access to care and make the results hard to apply to
women with different insurance, the authors note. They also may not
have had complete data on some aspects of supportive care such as
counseling.
It's also possible that differences in financial resources among
patients could have contributed to the disparities in treatment and
differences in outcomes, said Dr. Sharon Giordano, chair of health
services research at The University of Texas MD Anderson Cancer
Center in Houston.
"Those patients who had limited financial resources could have been
less able to pay for medications, including medications that were
prescribed to help with symptom control," Giordano, who wasn't
involved in the study, said by email.
At the same time, the findings add to a growing body of evidence
suggesting that race plays a role in how cancer patients get
treated.
"Other studies have found that patients who enroll in hospice have
better quality of life and longer survival," Giordano said. "One
could hypothesize that the patients who have good control of their
symptoms are more comfortable having their care managed at home
through a hospice program."
SOURCE: http://bit.ly/1Wt50Mj Journal of Clinical Oncology, online
May 9, 2016.
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