Black women with breast cancer face earlier disease onset, more aggressive disease, and higher mortality rates. Additionally, Black women may deal with racial bias from health care providers and treatment plans that fall below the standard of care.
Place of death can be a metric for high-quality care at the end of life as hospital death is correlated with physical and emotional distress. This study, published in Cancer Epidemiology, Biomarkers & Prevention, aimed to better understand the role place of death plays in end-of-life breast cancer disparities.
Researchers utilized the National Center for Health Statistics database to determine the place of death for all U.S. women with primary breast cancer death from 1999-2019. Place of death, including hospital, home, and hospice, and race, including Black and white, were considered. Additionally, a subset of women who died before age 40 was also analyzed.
Over the years studied, there were 867,213 women who died from breast cancer. Home deaths increased by 5.7% and 6.2% in white and Black patients, respectively. Hospital deaths decreased by -11.4% in white patients and -14.4% in Black patients. Hospice death was not added as a category in the database until 2003.
From 2003-2019, hospice death increased similarly among white and Black patients. However, in 2019, it was found that white patients were 1.24 times more likely to die at home and 1.02 times more likely to die in hospice than Black patients. Black patients were 1.65 times more likely to die in the hospital. Among patients who died before age 40 in 2019, white patients were 1.4 times more likely to die at home than Black patients.
Although home deaths have increased significantly over time, place of death disparities related to race remain. Black patients with breast cancer experience disproportionately higher hospital deaths and fewer home deaths than white patients. There may be a number of factors leading to these disparities, such as cultural preference, poor physician communication about end-of-life options, or incorrect prognoses that limit patients and caregivers in making decisions about end-of-life care.
As home death has been correlated with better patient outcomes, such as symptom control and autonomy, additional research is needed to improve patient-physician communication and culturally sensitive end-of-life care for Black patients with breast cancer .
Source: Marion, S., & Chino, F. (2022). Abstract PO-124: Should place of death be added to the index of disparities between Black and white breast cancer patients? Cancer Epidemiology, Biomarkers & Prevention. https://doi.org/10.1158/1538-7755.disp21-po-124