In a retrospective cohort study, racial disparities in the use of medications and interventions near end of life were observed among patients with advanced gynecologic cancer.
Palliative medicine improves outcomes in patients with gynecologic malignancies. Studies on palliative medicine in cancer have minimal representation from minority groups. A retrospective cohort study published in the journal Cancer Control evaluated the racial and ethnic differences in palliative medicine referrals and end-of-life interventions in a diverse population of gynecologic cancer patients.
Study Population
The study comprised 186 patients. Most patients spoke English as their primary language (69.9%), with 24.2% speaking Spanish. Approximately half of the patients were White (49.5%), 24.7% were Black, and 22.6% were Hispanic. The mean age at diagnosis was 58 years. The most common malignancies were ovarian (37.6%) and uterine (32.8%). Over 75% of patients had Stage III or IV disease at diagnosis.
Patterns of Palliative Medicine Referral and End-of-Life Interventions Revealed
Of the 186 patients, 82 (44.2%) were provided with palliative medicine referrals, with 67 (37%) patients ultimately seeing a palliative medicine provider. Symptom management was the most common (73%) indication for palliative medicine referral. Symptom management comprised recommendations of care for cancer-related symptoms, such as pain, nausea, insomnia, etc. Highly used medications included analgesics (84.4%), anti-emetics (76.3%), and bowel regimens (60.2%). Chemotherapy and interventional procedures were noted in 5.9% of the patients in the last 30 days of life.
Racial Differences in Symptom-Relieving and End-of-Life Interventions
There were no racial differences in palliative care referrals. However, racial differences were observed in specific tools for alleviation of symptoms and in interventions near the end of life. Analysis by patient race demonstrated that a higher proportion of Black patients (41%) were prescribed appetite stimulants as compared to White patients (24%) (P = 0.038). A higher number of emergency department visits and hospitalizations were observed in Black patients (P = 0.035). A higher proportion of Black patients received chemotherapy in the last 30 days of life than White patients (38.8% vs. 12%, P = 0.019). Analysis by patients’ spoken language showed that the language spoken was not significantly associated with medication use or interventions in the last 30 days of life.
Ovarian Cancer Patients May Not Complete Palliative Medicine Consultation
Among patients who were referred to palliative medicine but did not consult, organ site was the only significant variable, with ovarian cancer patients being less likely to complete a consultation compared to patients with uterine, cervical, or vulvar cancer. However, no clear conclusions could be drawn regarding patient populations more at risk for non-completion of consultation due to the small sample size of patients who did not complete palliative medicine consultations despite referral.
Source:
Tabuyo-Martin, A., Torres-Morales, A., Pitteloud, M. J., Kshetry, A., Oltmann, C., Pearson, J. M., Khawand, M., Schlumbrecht, M., & Sanchez, J. C. (2023b). Palliative Medicine referral and End-of-Life interventions among racial and ethnic minority patients with advanced or recurrent gynecologic cancer. Cancer Control, 30, 107327482311571. https://doi.org/10.1177/10732748231157191
