Racial Disparities in End-of-Life Care Among Patients With Prostate Cancer: A Population-Based Study

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  • a From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Objective: To examine racial disparities in end-of-life (EOL) care among black and white patients dying of prostate cancer (PCa). Methods: Relying on the SEER-Medicare database, 3789 patients who died of metastatic PCa between 1999 and 2009 were identified. Information was assessed regarding diagnostic care, therapeutic interventions, hospitalizations, intensive care unit (ICU) admissions, and emergency department visits in the last 12 months, 3 months, and 1 month of life. Logistic regression tested the relationship between race and the receipt of diagnostic care, therapeutic interventions, and high-intensity EOL care. Results: Overall, 729 patients (19.24%) were black. In the 12-months preceding death, laboratory tests (odds ratio [OR], 0.51; 95% CI, 0.36–0.72), prostate-specific antigen test (OR, 0.54; 95% CI, 0.43–0.67), cystourethroscopy (OR, 0.71; 95% CI, 0.56–0.90), imaging procedure (OR, 0.58; 95% CI, 0.41–0.81), hormonal therapy (OR, 0.53; 95% CI, 0.44–0.65), chemotherapy (OR, 0.59; 95% CI, 0.48–0.72), radiotherapy (OR, 0.74; 95% CI, 0.61–0.90), and office visit (OR, 0.38; 95% CI, 0.28–0.50) were less frequent in black versus white patients. Conversely, high-intensity EOL care, such as ICU admission (OR, 1.27; 95% CI, 1.04–1.58), inpatient admission (OR, 1.49; 95% CI, 1.09–2.05), and cardiopulmonary resuscitation (OR, 1.72; 95% CI, 1.40–2.11), was more frequent in black versus white patients. Similar trends for EOL care were observed at 3-month and 1-month end points. Conclusions: Although diagnostic and therapeutic interventions are less frequent in black patients with end-stage PCa, the rate of high-intensity and aggressive EOL care is higher in these individuals. These disparities may indicate that race plays an important role in the quality of care for men with end-stage PCa.

Correspondence: Firas Abdollah, MD, Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202-2689. E-mail: firas.abdollah@gmail.com, fabdoll1@hfhs.org

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