INDIANAPOLIS, IN — While disparities in lung cancer mortality among racial and ethnic minorities are well documented, not as much is understood about how racial and ethnic minority patients with lung cancer are treated at the end of life.
A study led by researchers from the Indiana University School of Medicine and the Richard L. Roudebush VAMC, both in Indianapolis, sought to determine if those patients experience higher rates of intensity of care at the end of life (EOL) compared with non-Hispanic white (NHW) patients.
To do that, the study team conducted a population-based analysis of adult patients with a lung cancer diagnosis who died between 2005 and 2018 using the California Cancer Registry linked to patient discharge data abstracts. Defined as the primary outcome in the study in the Journal of Clinical Oncology was intensity of care in the last 14 days before death (defined as any hospital admission or emergency department [ED] visit, intensive care unit [ICU] admission, intubation, cardiopulmonary resuscitation [CPR], hemodialysis, and death in an acute care setting). 1
Among the 207,429 patients with lung cancer who died from 2005 to 2018 and were included in the study, the median age was 74 years (range, 18-107) and 106,821 (51%) were male. Most of the patients, 70.8%, were NHW, 10.8% Hispanic, 10.5% were Asian Pacific Islander (API) and 0.5% were American Indian.
Results indicated that, compared with NHW patients in the last 14 days before death, API, Black, and Hispanic patients had greater odds of a hospital admission, an ICU admission, intubation, CPR, and hemodialysis and greater odds of a hospital or ED death.
“Compared with NHW patients, API, Black, and Hispanic patients who died with lung cancer experienced higher intensity of EOL care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the EOL,” the authors wrote.
An earlier study in the Journal of Geriatric Oncology found that most lung cancer decedents experienced a pattern of low- or decreasing-intensity care over the six-month EOL period. The Yale University-led researchers found associations between trajectory type and decedent demographics, cancer characteristics, and contextual measures.2
“Older age at death, higher area hospice use, and earlier stage at diagnosis were associated with low and decreasing intensity, while Black race and residence in the South and in larger metropolitan areas were associated with lower probabilities of lower-intensity trajectories. These patterns suggest targets for further exploration and potential intervention,” they wrote.
- Rodriguez GM, Popat R, Rosas LG, Patel MI. Racial and Ethnic Disparities in Intensity of Care at the End of Life for Patients With Lung Cancer: A 13-Year Population-Based Study. J Clin Oncol. 2024 Mar 13:JCO2301045. doi: 10.1200/JCO.23.01045. Epub ahead of print. PMID: 38478794.
- Davidoff AJ, Canavan ME, Prsic E, Saphire M, Wang SY, Presley CJ. End-of-life care trajectories among older adults with lung cancer. J Geriatr Oncol. 2023 Jan;14(1):101381. doi: 10.1016/j.jgo.2022.09.010. Epub 2022 Oct 4. PMID: 36202695; PMCID: PMC9974538.