Racial disparities identified in some quality-of-life-oriented care for breast cancer patients

A study led by UNC Lineberger researchers determined that black women with advanced breast cancer were less likely to receive supportive care medications, like antidepressants and sleep aids, than white patients. They also were less likely to enroll in hospice care, and more likely to get intensive treatment at the end of their lives.

Racial disparities identified in some quality-of-life-oriented care for breast cancer patients click to enlarge Devon Check is a graduate of the UNC Gillings School of Global Public Health.

Caring for the symptoms and side effects of cancer – both psychological and physical – can improve patients’ quality of life. But a University of North Carolina Lineberger Comprehensive Cancer-led study has found that not all breast cancer patients were getting such supportive care at the same rates.

The researchers determined that black women with advanced breast cancer were less likely to receive supportive care medications, like antidepressants and sleep aids, than white patients. They also were less likely to enroll in hospice care, and more likely to get intensive treatment at the end of their lives.

“We saw disparities in the use of drugs that are often used to treat depression, anxiety and insomnia,” said the study’s lead author Devon Check, PhD. “Black women were half as likely as white women to receive these medications, and they were also less likely to use hospice and more likely to receive intensive end of life care.”

The findings, published in the Journal of Clinical Oncology, build on previous research that identified disparities in the use of palliative care, which focuses on relieving disease symptoms and treatment side effects, and hospice care.

In the new study, researchers wanted to know if patients were more likely to receive palliative or hospice care at the end of life if they received supportive care early in their treatment.

They analyzed data from Medicare to check for use of pain medications, antidepressants and other supportive care medications, for 883 women with stage IV breast cancer who died between 2007 and 2012 in the 90 days after diagnosis.

While there were no disparities in use of opioid medications intended to reduce pain, black women were half as likely as white women to receive medications to relieve anxiety, depression and insomnia, 16 percent compared to 32 percent respectively.

“These are concerning findings because they could point to inadequate symptom management among black women, and potentially reduced quality of life,” Check said.

The researchers are determined that black women were 16 percent more likely to die in the hospital, and 11 percent more likely to be admitted to the intensive care unit or more than one hospitalization in the final 30 days of life. They also were 11 percent less likely to use hospice than white women.

Check said that there were some potential limitations to the study, including patients could have used other forms of early supportive care there were not accounted for in their claims data, such as counseling and decision support. She also said the study did not account for patient preference.

“The racial disparities in end of life care, or at least differences in patterns of care, could be explained by cultural or attitudinal factors concerning preferences for end of life care,” she said.

In addition to Check, the other authors are Cleo A. Samuel, Gillings School of Global Public Health and the UNC Lineberger Cancer; Donald L. Rosenstein, UNC School of Medicine and UNC Lineberger; and Stacie B. Dusetzina, UNC Eshelman School of Pharmacy, UNC Gillings School of Global Public Health and UNC Lineberger.

The study was supported by the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health K12 Program and the North Carolina Translational and Clinical Sciences Institute. Individual researchers were also supported by the National Cancer Institute of the National Institutes of Health.