Intensity of End-of-Life Care for Patients with Hematologic Malignancies and the Role of Race/Ethnicity
Menée aux Etats-Unis à partir de données portant sur des patients atteints d'un cancer hématologique, cette étude de cohorte rétrospective analyse les disparités ethniques dans l'intensité des soins de fin de vie et dans l'utilisation de soins palliatifs pendant les 30 derniers jours de vie
Background: Racial/ethnic minority patients with nonhematologic malignancies (non-HM) have lower rates of hospice care, advance directive use, and palliative care utilization than non-Hispanic white (NHW) patients. Less is known regarding racial/ethnic minority patients with hematologic malignancies (HM). Objectives: To study hospital utilization among racial/ethnic minority patients with HM and compare end-of-life outcome measures to patients with non-HM. Methods: We performed a retrospective cohort study (2010–2015) using electronic health records from an integrated academic health center to study differences in hospital utilization patterns and documentation of advance care planning between patients with HM and non-HM. In the subgroup with hematologic malignancy, we examined outcomes associated with racial/ethnic minority status. Results: Among all patients in the last 30 days of life, those with HM had higher rates of inpatient care (odds ratio [OR], 1.96; 95% CI: 1.74–2.20; p < 0.001) and intensive care unit (ICU) care (OR, 3.50; 95% CI: 3.05–4.03; p < 0.001). Patients with HM were more likely to die in a hospital (OR, 2.75; 95% CI: 2.49–3.04; p < 0.001) than those with non-HM. Furthermore, during the last 30 days of life, among patients with HM, racial/ethnic minority patients were more likely to have more than one emergency room visit (OR, 6.81; 95% CI: 1.34–33.91; p = 0.02), 14+ days of inpatient care (OR, 1.60; 95% CI: 1.08–2.35; p = 0.02), longer stays in the ICU (OR, 1.26; 95% CI: 1.04–1.52; p = 0.02), and lower rates of advance directive documentation (OR, 0.60; 95% CI: 0.44–0.82; p < 0.01) than NHWs. Conclusion: Our findings suggest that racial/ethnic minority patients with HM have higher utilization of care at the end-of-life and lower rates of advance directives compared with NHW patients.