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

2016 ◽  
Vol 34 (19) ◽  
pp. 2265-2270 ◽  
Author(s):  
Devon K. Check ◽  
Cleo A. Samuel ◽  
Donald L. Rosenstein ◽  
Stacie B. Dusetzina
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
End Of Life ◽  
End Of Life Care ◽  
White Women ◽  
Medication Use ◽  
Stage Iv ◽  
Life Care ◽  
Black And White ◽  
Stage Iv Breast Cancer

Purpose Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care. Methods We used 2007 to 2012 SEER-Medicare data to evaluate use of supportive medications (opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids) in the 90 days postdiagnosis among black and white women with stage IV breast cancer who died between 2007 and 2012. We used modified Poisson regression to assess the relationship between race and supportive treatment use and end-of-life care (hospice, intensive care unit, more than one emergency department visit or hospitalization 30 days before death, in-hospital death). Results The study included 752 white and 131 black women. We observed disparities in nonopioid psychotropic use between black and white women (adjusted risk ratio [aRR], 0.51; 95% CI, 0.35 to 0.74) but not in opioid pain medication use. There were also disparities in hospice use (aRR, 0.86; 95% CI, 0.74 to 0.99), intensive care unit admission or more than one emergency department visit or hospitalization 30 days before death (aRR, 1.28; 95% CI, 1.01 to 1.63), and risk of dying in the hospital (aRR, 1.59; 95% CI, 1.22 to 2.09). Supportive medication use did not attenuate end-of-life care disparities. Conclusion We observed racial disparities in early supportive medication use among patients with stage IV breast cancer. Although they did not clearly attenuate end-of-life care disparities, medication use disparities may be of concern if they point to disparities in adequacy of symptom management given the potential implications for quality of life.

Outcomes for black versus white women with stage IV breast cancer enrolled on investigator-initiated clinical trials at Emory.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1086-1086
Author(s):  
Princess Ekpo ◽  
Mylin Ann Torres ◽  
Manali Rupji ◽  
Jeffrey M. Switchenko ◽  
Preeti Subhedar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Clinical Trials ◽  
Black Women ◽  
White Women ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Black And White ◽  
Stage Iv Breast Cancer ◽  
Significant Difference

1086 Background: Black women are 40% more likely to die from their breast cancer compared to White women. Inadequate representation of Blacks in clinical trials may contribute to health care inequity. Emory’s Winship Cancer Institute (WCI) in Atlanta serves a significant Black population and has a unique opportunity to engage these underrepresented patients in clinical trials. We aimed to assess clinical outcomes in Black versus White women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials (IITs) at Emory. Methods: Black and White women with MBC enrolled on IITs conducted at WCI between 1/2009 and 1/2019 were retrospectively evaluated. Descriptive statistics were generated for all patient characteristics. Univariate analyses and a multiple logistic regression model were used to assess the effect of age and race on clinical response, length of time on trial, number of therapy lines prior to trial enrollment, and toxicity on trial. Overall survival was assessed using Kaplan Meier analysis. Results: Sixty-two women with MBC were included [White, n = 41 (66%), and Black, n = 21 (34%), p = 0.55]. Over 90% of women were enrolled on phase II clinical trials and received targeted therapy. Mean age at clinical trial consent was 53.2 and 55.9 years in Black and White women, respectively (p = 0.36). While the majority of women had hormone-receptor positive disease, a higher percentage of Blacks had triple negative breast cancer (29% vs. 17% in Whites, p = 0.39). Black women had fewer lines of systemic therapy prior to trial enrollment (2.86 vs. 4.3, respectively, p = 0.017) and were enrolled on trial for less time than White women (5.67 mo vs. 7.83 mo, respectively, p = 0.22). There were no differences in toxicity rates among patients enrolled on IITs based on race. Black women were more likely to have progressive disease (PD) on trial (45% in Blacks vs. 20% in Whites, p = 0.05). While there was no significant difference in overall survival (p = 0.482), there was a trend towards shorter survival in Black women (51.3 mos vs. 64 mos, respectively). Conclusions: Black women with MBC who enrolled on IIT trials at Emory had worse treatment response and a trend towards poorer survival compared to White women. More research is needed to determine whether this is due to adverse biology. These results reinforce the need for exploration of biomarkers of response by race and ethnicity and improved representation of Blacks in clinical trials to inform real world efficacy.

scholarly journals Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 472-472
Author(s):  
Jenny McDonnell
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Black Americans ◽  
Low Ses ◽  
Care Planning ◽  
Life Care ◽  
Black And White ◽  
Advance Care ◽  
Using Data

Abstract While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P<0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.

Factors Affecting Racial Disparities in End-of-Life Care Costs Among Lung Cancer Patients

2019 ◽  
Vol 42 (2) ◽  
pp. 143-153 ◽  
Author(s):  
Siddharth Karanth ◽  
Suja S. Rajan ◽  
Frances L. Revere ◽  
Gulshan Sharma
Keyword(s):  
Lung Cancer ◽  
Racial Disparities ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Life Care ◽  
Factors Affecting ◽  
Lung Cancer Patients ◽  
Care Costs

Is the proportion of patients with synchronous stage IV breast cancer surviving > 2 years increasing over time?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 524-524 ◽  
Author(s):  
Shaheenah S. Dawood ◽  
Benjamin Haaland ◽  
Constance T. Albarracin ◽  
Ana M. Gonzalez-Angulo ◽  
Sudeep Gupta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stage Iv ◽  
P Value ◽  
Lower Grade ◽  
Moderate Increase ◽  
Multivariable Logistic Regression Model ◽  
Black And White ◽  
Stage Iv Breast Cancer ◽  
Interaction Term ◽  
Over Time

524 Background: Studies have shown a moderate increase in survival over time among pts with stageIV breast cancer. Median survival is approximately 2 yrs. The aim of this study was to evaluate trends over time of pts with synchronous stage IV disease who survive >2 yrs. Methods: Using the SEER registry we identified female pts with synchronous stage IV breast cancer diagnosed between 1990-2007. Pts were divided into 3 groups according to year of diagnosis(1990-1995, 1996-2000, 2001-2007). Probability of surviving more than >2 yrs was computed within each group. A multivariable logistic regression model was then fitted to determine the association between year of diagnosis and the probability of surviving >2 yrs after adjusting for other prognostic factors. Results: 22,492 pts were identified of whom 9,388 (41.7%) had a survival of >2 yrs. The probability of surviving >2 yrs was 36.2%, 40.1%, and 44.2% among pts diagnosed in periods 1990-1995, 1996-2000, and 2001-2007 respectively (p-value < 0.0001). The probability of surviving >2 yrs was 55.3% and 29.3% among pts with ER+ and ER- disease respectively (p-value <0.0001) and was 32.9% and 43.5% among pts of black and white race respectively (p-value <0.0001). In the multivariable model the probability of surviving >2 yrs increased with increasing year of diagnosis (OR 1.04, 95% CI 1.03-1.05, p <0.0001). Other factors significantly associated with an increased probability of surviving >2 yrs included radiation therapy, lower grade, younger age, hormone receptor (HR) positive disease and non-inflammatory disease. Interaction term between race and year of diagnosis was marginally significant, such that black pts had a more slowly increasing probability of surviving >2 yrs compared to whites (OR 0.97, 95% CI 0.96-1.00, p = 0.037). Interaction term between HR status and year of diagnosis was not significant. Conclusions: Our results indicate that among pts with synchronous stage IV breast cancer the probability of surviving >2 yrs has increased over time reflecting the introduction and FDA approval of multiple efficacious chemotherapeutic and endocrine therapeutic options. Of concern, the probability of surviving >2 yrs has increased more slowly among pts of black race.

The Quality of End-of-Life Care for Women Deceased From Metastatic Breast Cancer

2021 ◽  
Vol 23 (3) ◽  
pp. 238-247
Author(s):  
Rachel L. Brazee ◽  
Bethany D. Nugent ◽  
Susan M. Sereika ◽  
Margaret Rosenzweig
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Metastatic Breast ◽  
Life Care
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