ASPO Abstracts
End of life care quality for American Indian patients with cancer in North Carolina
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: American Indians (AI) experience significant disparities in access to timely cancer screening and curative intent treatment leading to worse cancer mortality; however, little is known about the quality of end-of-life (EOL) care in AI patients with cancer. Thus, we sought to describe EOL care in a large population-based cohort of AIs with cancer. Methods: We retrospectively analyzed EOL care for decedents who were diagnosed with any cancer in 2003 through 2018 in using the University of North Carolina's Cancer Information and Population Health Resource (CIPHR) which includes statewide cancer registry data linked to public and private health insurance claims. Eligible decedents included those with insurance coverage during the month of and before death. Measures of EOL care quality included hospice use in the last 30 days of life as well as existing measures of poor-quality EOL care–intravenous chemotherapy, hospital admission, ICU admission, and >1 emergency department (ED) visit in the last 30 days of life, hospice initiation in the last 3 days of life, and in-hospital death. Associations between patient race (AI vs. White) and EOL care were examined, adjusting for age, sex, health insurance, and rurality. Results: We identified 167,482 decedents in the CIPHR cohort (1,812 AI and 165,670 White individuals). AI patients had greater proportions of rural residence (54.0% vs. 30.3%) and Medicaid (60.0% AI vs. 27.8%) than White patients. Compared with White patients, AI patients had increased hospital admission (adjusted risk ratio [aRR], 1.12, 95% confidence interval [CI], 1.07-1.16), ICU admission (aRR, 1.22; 95% CI, 1.11-1.34), and >1 ED visit (aRR, 1.36; 95% CI, 1.24-1.49) in the last 30 days of life. Other factors associated with low-quality EOL care included younger age, Medicaid, and rurality. Conclusions: AI patients and patients with Medicaid and rural residence experienced more aggressive EOL care, suggesting opportunities to optimize high-quality culturally appropriate EOL care in these groups. Better understanding of the unique and complicated physician/patient decision making around EOL care is needed, particularly for AI and other medically underserved patients who may lack insurance and access to consistent, high quality medical care.
Keywords: End-of-life care quality, American Indian, Cancer