ASPO Abstracts
Racial differences in continuity of care and aggressive end-of-life care among women dying with ovarian cancer in SEER-Medicare
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose: End-of-life care for women with ovarian cancer is aggressive, and more aggressive for nonwhite women.
However, whether continuity of care near the end of life reduces aggressive care remains unknown. The purpose
of this study was to evaluate the association of care continuity with receipt of aggressive end-of-life care, and to
explore differences by patient race.
Methods: This study included women with ovarian cancer who are over age 66, died between 2007 and 2016, and
had continuous Medicare coverage in the Surveillance Epidemiology and End Results (SEER)-Medicare data
linkage. The Continuity of Care Index (COC) was calculated for outpatient evaluation and management visits in
the year prior to death (excluding the final month when outcomes were assessed). Multivariable logistic regression
models were used to estimate the associations between race and COC with aggressive end-of-life care in the last
month of life including: hospice (no or late), hospital utilization (ED visits, ICU stay, multiple/terminal
hospitalization) and treatments (chemo, invasive procedures, life extending procedures).
Results: Among 6,472 women dying of ovarian cancer, the average COC score was 0.38, and COC distribution
across tertiles differed by race (p<0.01), with NHB women having the largest proportion in the lowest tertile
(39.7%), and Hispanic women having the greatest proportion in the highest tertile (40.5%). More than half of the
women (51.7%) had at least one indicator of aggressive end-of-life care, with more aggressive care in Non-
Hispanic Black (NHB) women (64.2%) compared to white women (50.1%) (P < 0.01). In race adjusted models,
compared to women in the lowest COC tertile, those in the top COC tertile had lower odds of receiving a life
extending procedure (adjusted OR 0.73 CI 0.59-0.89), invasive procedure (adjusted OR 0.68 CI 0.58-0.79), or
having a stay in the ICU (adjusted OR 0.84 CI 0.72-0.97).
Conclusions: Although higher care continuity was associated with lower odds of some aggressive end of life care,
and care continuity differed across racial/ethnic groups, it was not sufficient to explain the higher odds of
aggressive care seen among nonwhite women with ovarian cancer.
Keywords: racial disparity, ovarian cancer, end-of-life care