Dr. Cole abstracted data on men older than 40 years of age, with metastatic prostate cancer within the National Cancer Database. The receipt of palliative care was compared in each racial group. Hospitals in the top decile in terms of the proportion of Black and Hispanic patients were defined as minority-serving hospitals (MSHs). The primary outcome was receipt of palliative care, encompassing medical, surgical, or radiation treatments performed with palliative but not curative intent. A multilevel logistic regression model estimating the odds of receiving palliative care based on MSH status was fit, adjusting for year of diagnosis, sex, race, insurance, income, and education, with a hospital-level random intercept to account for unmeasured hospital characteristics.
The cohort consisted of 44,521 men with metastatic prostate cancer, with a mean age of 71.3 (95% CI 71.1-71.6) years of age. Of these men, 7096 (15.9%) were treated at MSHs. The population of men treated at MSHs was 30% white and 66% were either black or Hispanic. The population treated at non-MSHs was 78% white and 18% were black or Hispanic. The proportion of men of receiving palliative care differed based on race: 15.9% of white men received palliative care for prostate cancer, whereas only 14.7% of black men and 12.0% of Hispanics received palliative care (p < 0.001). In the model adjusting for clinical and demographic variables, and minority-serving hospital status, MSH status had a large and statistically significant association with lower odds of palliative care (OR 0.67 95% CI 0.55-0.82), whereas Black and Hispanic race did not (OR 1.00, 95%CI 0.91-1.09) and (OR 0.98, 95%CI 0.85-1.13).
Dr. Cole listed several limitations of their study, including (i) palliative treatments were defined in a way that is broader than subspecialty palliative care, (ii) there was a focus on black/Hispanic in definition of minority service hospitals rather than other underserved US populations, and (iii) this is not a fully representative sample of hospitals (only Commission on Cancer accredited institutions) and it is possible that these results are an underestimation. Despite these aforementioned limitations, this study is extremely important and provides actionable targets for change.
Dr. Cole concluded with several remarks:
- In the adjusted model, treatment at an MSH had a large and statistically significant impact on receipt of palliative care; patient race did not.
- These findings suggest that the site of care may account for much of the observed race-based disparities in palliative care in prostate cancer.
- Targeting MSHs may represent an effective strategy to combat disparities in palliative care.
Presented by: Alexander P Cole, MD, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Co-authored by: Akezhan Meirkhanov, Sean Anthony Fletcher, Zara Cooper, Stuart R. Lipsitz, Joel S. Weissmann, Kerry L. Kilbridge, Adam S. Kibel, Quoc-Dien Trinh, Boston, Massachusetts
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University - Medical College of Georgia, Twitter: @zklaassen_md at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
References:
1. Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med 2007 Jun 11;167(11):1177-1182.