Race and ethnicity affect use of hospice services among patients with advanced cancer

Race and ethnicity appear to have an effect on whether a patient with terminal cancer uses hospice care services, according to a study led by researchers at Beth Israel Deaconess Medical Center (BIDMC).

Published in the January 2009 issue of the Journal of the American Geriatrics Society ( JAGS ), the findings demonstrate that blacks and Asians with terminal cancer use end-of-life services less frequently than do whites and Hispanics.

According to senior author Ellen McCarthy, PhD, of BIDMC's Division of General Medicine and Primary Care, the researchers studied the records of 41,000 terminal cancer patients over age 65. All received their health insurance coverage through Medicare. After accounting for a number of other factors - including income and physical health - their findings showed that compared with whites and Hispanics, black and Asian patients were more likely to be hospitalized frequently, to be hospitalized for prolonged periods, to receive care in an intensive care unit (ICU), and to die in the hospital. Compared with the other patients, black patients were nine percent less likely to enroll in a hospice program and Asian Americans were 24 percent less likely to do so. These same two population groups were also 26 percent and 17 percent more likely, respectively, to be hospitalized in the intensive care unit at least twice during their last month of life.

"Going forward, it will be important to find out whether patients' personal preferences, unequal access to health care, or both are fueling racial differences in end-of-life care," explains the study's lead author Alexander Smith, MD, a former fellow in the Harvard General Medicine Fellowship Program at BIDMC. "Minority patients may be bearing the burdens of high-intensity care at the end of life, without realizing the benefits of hospice and palliative care."

Adds McCarthy, "In order to develop effective strategies to promote hospice and palliative care services for these underserved populations, further research is needed to clarify the extent to which racial and ethnic differences in end-of-life care are due to cultural factors versus inequities in care."