Prostate cancer (PCa) is the most common noncutaneous cancer and the second leading cause of cancer-related death in North American men.1 In the United States, 233,000 new cases of PCa are estimated to be diagnosed in 2014, along with 29,480 PCa-related deaths.1 Several patients with terminal metastatic PCa are confronted with difficult choices at both ends of the spectrum, ranging from aggressive end-of-the-line anticancer therapy to hospice care.
End-of-life (EOL) care represents a challenge for both the patient and the physician. The physician-patient, through honest and empathic communication, must decide when high-intensity care is no longer beneficial and when the goals of care shift to focus on continued intense symptom management and quality EOL care. Continued high-intensity care, including intensive care unit (ICU) admissions, emergency department (ED) visits, acute-care hospital visits, and use of new anticancer therapies very close to death, lead to unpropitious physical, psychological, and monetary effects at EOL.2–7
Despite the well-established disparities in quality of PCa care between white and black patients,8–12 how this relationship applies to EOL care in the context of advanced PCa is unclear. Qualitative research, across multiple cancers, suggests the existence of such disparities between white and black patients at EOL, with prior studies showing that black patients with end-stage cancers are at increased risk for receiving high-intensity EOL care relative to white patients.8–12 It has been hypothesized that this may be due to to the lack of awareness among black patients about palliative and hospice care, the prohibitive cost of care, a mistrust of the system, and poor physician-patient communication.13–17
However, none of these studies focused specifically on advanced PCa, which is usually known to be more frequent in black men.18 To address this void, we sought to examine the impact of race on the use of EOL resources, with emphasis on the use of high-intensity care among patients with PCa during the last year of life.
Dr. Abdollah is a consultant for GenomeDx biosciences. Dr. Nguyen is a consultant for Ferring and Medivation. Dr. Kibel is a consult for Sanofi-Aventis, Dendreon, and Myriad. Dr. Trinh is supported by the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at the Brigham and Women's Hospital. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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