Racial disparities in length of stay in hospice care by tumor stage in a large elderly cohort with non-small cell lung cancer

Abstract

This study examined whether there are racial disparities for length of stay in hospice for patients with non-small cell lung cancer (NSCLC).We studied 53,626 deceased patients aged ≥66 years diagnosed with American Joint Committee on Cancer stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Results-Medicare linked data who used hospice services in the last six months before death, and died between 1 January 1991 and 31 December 2005. Median time (days) and percent length of stay in hospice, and multivariate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) using zero-truncated negative binomial regression described relationships. In 2000-2005, most patients (64.1%) had <30 days, including those (30.2%) with <7 days length of stay in hospice care. After adjusting for confounders, the IRR for length of stay in hospice compared to whites was 38% increased for blacks (IRR = 1.38; 95% CI: 1.01-1.89), and almost three-fold increased for Hispanics (IRR = 2.91;95% CI: 1.15-7.37) at stages I-II. However, blacks at stages III-IV had slightly decreased use of hospice services (IRR = 0.91; 95% CI: 0.85-0.97). Length of stay decreased slightly among blacks diagnosed with late stage (III-IV) NSCLC in 2000-2005.The gap in disparity for length of stay in hospice has narrowed for ethnic minorities compared to whites, while some ethnic minorities had greater length of stay at early disease stage.

Clinical profile of patients diagnosed with primary lung cancer at the Pulmonology Division, Universitas Academic Hospital, Bloemfontein, 2010-2011

“…However, it should be noted that conflicting results on the relationship between histological subtypes of lung cancer and ethnicity have been reported. [14][15][16][17][18][19] In contrast to our findings, a recent study in the USA on 1 812 African American patients with lung cancer, reported that 41.8% had adenocarcinoma and 20.6% SCC. 20 Apart from smoking status and total number of pack years, other factors that could possibly contribute to the observed differences in patients with lung cancer of African and Caucasian ethnicity have been investigated and reported in the literature.…”

“…Hardy et al 14 found that 69.1% of black patients were in the poorest quartile, as opposed to 19% of white patients, in a comparative study on patients with lung cancer in the USA. Conversely, 27.6% of white patients were in the highest quartile, compared to only 5.1% of black patients.…”

“…32 Employment, which is linked to level of education to a certain extent, plays a fundamental role in socio-economic status and financial security. Therefore, it could be argued that if poverty is indeed associated with an increased risk of lung cancer, as recently suggested, 14,26 the black population in South Africa is challenged with a combination of confounding factors with regard to the development and outcome of lung cancer.…”

Ethnic differences in hospice enrollment following inpatient palliative care consultation

“…A study of California dual eligibles found that blacks were 26% and Asians 34% less likely than whites to use hospice. Others have found similar results among patients with CHF and lung cancer …”

Fluid Biopsy for Solid Tumors: A Patient’s Companion for Lifelong Characterization of Their Disease

“…The patient’s physician will then select a new drug or combination, and the cycle will repeat itself, although with each subsequent cycle the probability of achieving a response becomes less and the duration of remission becomes shorter: 2–10 months for the second-line therapy, 0–5 months for the third-line and so forth. After receiving a therapy that is unsuccessful, the patient’s cancer grows, the performance status of the patient declines and they are deemed no longer fit enough to receive drug therapy, with death usually following within less than 1 month [2]. It is the goal of cancer physicians and scientists to change this natural history of cancer.…”