Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer

Check, Devon K.; Samuel, Cleo A.; Rosenstein, Donald L.; Dusetzina, Stacie B.

doi:10.1200/jco.2015.64.8162

Cited by 45 publications

(46 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to underuse of services, disparities also exist with overuse of treatment in the EOL setting. Compared to elderly white women, elderly black women with MBC are more likely to die in the hospital, and be admitted to the ICU, hospital, or ED within the last month of life [34]. These results are also similar to our own results which found that elderly black women with MBC were more likely to utilize aggressive EOL care compared to elderly white women with MBC.…”

Section: Discussionsupporting

confidence: 82%

“…Previous research has shown significant racial/ethnic disparities related to adequacy of pain and symptom control, and perceived unmet needs for supportive services [31–34]. In addition, other studies have found that among patients with MBC at the EOL, elderly black women were less likely to utilize hospice [34].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, other studies have found that among patients with MBC at the EOL, elderly black women were less likely to utilize hospice [34]. In addition to underuse of services, disparities also exist with overuse of treatment in the EOL setting.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Association between survival time with metastatic breast cancer and aggressive end-of-life care

Accordino

Wright

Vasan

et al. 2017

Breast Cancer Res Treat

View full text Add to dashboard Cite

Purpose For women with stage IV breast cancer (BC), the association between survival time (ST) and use of aggressive end-of-life (EOL) care is unknown. Methods We used the SEER-Medicare database to identify women with stage IV BC diagnosed 2002–2011 who died by 12/31/2012. Aggressive EOL care was defined as receipt in the last month of life: >1 ED visit, >1 hospitalization, ICU admission, life-extending procedures, hospice admission within 3 days of death, IV chemotherapy within 14 days of death, and/or ≥10 unique physician encounters in the last 6 months of life. Receipt of aggressive EOL care and hospice in the last month of life were determined using claims, and multivariable analysis was used to identify factors associated with receipt. Costs of care were also evaluated. Results We identified 4521 eligible patients. Of these, 2748 (60.8%) received aggressive EOL care. Factors associated with aggressive EOL care were race (OR 1.45, 95% CI 1.19–1.81 for blacks compared to whites) and more frequent oncology office visits (OR 1.56, 95% CI 1.28–1.90). Patients who lived >12 months after diagnosis were less likely to receive aggressive EOL care (OR 0.44, 95% CI 0.38–0.52), and more likely to utilize hospice (OR 1.43, 95% CI 1.21–1.69) compared to patients who lived ≤6 months. Patients with a shorter ST had significantly higher costs of care per-month-alive compared to patients with longer ST. Conclusion Patients with a shorter ST were more likely to receive aggressive EOL care and had higher costs of care compared to patients who lived longer.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association between survival time with metastatic breast cancer and aggressive end-of-life care

Accordino

Wright

Vasan

et al. 2017

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…Perhaps most compelling among the negative findings is race, which previously has been correlated with increased receipt of aggressive interventions and intensive care use at the EOL in adult patients with cancer . A previous study conducted at this institution 8 years ago likewise showed that race did not affect EOL care planning or resuscitation status for children with cancer, but that study did not query potential disparities related to location of death .…”

Section: Discussionmentioning

confidence: 93%

Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

et al. 2018

View full text Add to dashboard Cite

Children with cancer who die in high-acuity inpatient settings often experience a high burden of intensive therapy at the end of life. Strategies to identify patients at higher risk of dying in the pediatric intensive care unit (PICU) have not been explored previously. This study finds that certain variables may predict PICU death for pediatric palliative oncology patients, including delayed palliative care involvement. Preemptive identification of patients at risk for PICU death affords opportunities to study the effects of earlier palliative care integration and increased discussions around preferred location of death on end-of-life outcomes for children with cancer and their families.

show abstract

“…Especially, recent studies of novel but costly cancer drugs reported that racial minority patients were less likely to use those drugs than non-minority patients [9, 10]. Prior work documented racial variation in receipt of traditional interferon-based HCV treatments, with lower rates of utilization for Blacks than for Whites, but medical factors explained some of that difference [10].…”

Section: Introductionmentioning

confidence: 99%

Racial-Ethnic Disparities in Uptake of New Hepatitis C Drugs in Medicare

Jung

Feldman

2016

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

Background Chronic hepatitis C is an important public health concern. Recently launched drugs to treat hepatitis C virus (HCV) infection are effective but costly. Uptake of innovative and expensive prescription drugs may not be even across patient groups. We examined racial-ethnic disparities in uptake of new HCV drugs in the first year of their use (year 2014) in Medicare. Methods The study population was Medicare beneficiaries who had chronic hepatitis C in 2013 or 2014 and who were continuously enrolled in Part D stand-alone Prescription Drug Plans in 2014. We examined trends in monthly uptake of new HCV drugs and adjusted annual uptake rates by race. We used logistic regressions to obtain adjusted odds ratios and adjusted differences in annual uptake rates. Results Monthly uptake of new HCV drugs was lower among Black Medicare patients than Whites or Hispanics in 2014. The racial gap in monthly uptake became narrower toward the end of the year. Adjusted odds of using new HCV drugs were 11% lower for Blacks with cirrhosis than Whites (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.84–0.95), and 16% lower for Blacks with HCV/HIV coinfection than Whites (OR = 0.81; 95% CI, 0.72–0.92). Annual uptake rates were not significantly different for Whites and Hispanics. Conclusions Black Medicare patients with cirrhosis or HCV/HIV coinfection had lower uptake rates than Whites in 2014. As utilization of new HCV drugs increases, continuing efforts will be necessary to ensure equal delivery of the drugs.

show abstract

Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer

Cited by 45 publications

References 53 publications

Association between survival time with metastatic breast cancer and aggressive end-of-life care

Association between survival time with metastatic breast cancer and aggressive end-of-life care

Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

Racial-Ethnic Disparities in Uptake of New Hepatitis C Drugs in Medicare

Contact Info

Product

Resources

About