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Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer.

Publication ,  Journal Article
Check, DK; Samuel, CA; Rosenstein, DL; Dusetzina, SB
Published in: J Clin Oncol
July 1, 2016

PURPOSE: Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care. METHODS: We used 2007 to 2012 SEER-Medicare data to evaluate use of supportive medications (opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids) in the 90 days postdiagnosis among black and white women with stage IV breast cancer who died between 2007 and 2012. We used modified Poisson regression to assess the relationship between race and supportive treatment use and end-of-life care (hospice, intensive care unit, more than one emergency department visit or hospitalization 30 days before death, in-hospital death). RESULTS: The study included 752 white and 131 black women. We observed disparities in nonopioid psychotropic use between black and white women (adjusted risk ratio [aRR], 0.51; 95% CI, 0.35 to 0.74) but not in opioid pain medication use. There were also disparities in hospice use (aRR, 0.86; 95% CI, 0.74 to 0.99), intensive care unit admission or more than one emergency department visit or hospitalization 30 days before death (aRR, 1.28; 95% CI, 1.01 to 1.63), and risk of dying in the hospital (aRR, 1.59; 95% CI, 1.22 to 2.09). Supportive medication use did not attenuate end-of-life care disparities. CONCLUSION: We observed racial disparities in early supportive medication use among patients with stage IV breast cancer. Although they did not clearly attenuate end-of-life care disparities, medication use disparities may be of concern if they point to disparities in adequacy of symptom management given the potential implications for quality of life.

Duke Scholars

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

July 1, 2016

Volume

34

Issue

19

Start / End Page

2265 / 2270

Location

United States

Related Subject Headings

  • White People
  • United States
  • Terminal Care
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Medicare
  • Humans
  • Healthcare Disparities
  • Female
  • Breast Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Check, D. K., Samuel, C. A., Rosenstein, D. L., & Dusetzina, S. B. (2016). Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer. J Clin Oncol, 34(19), 2265–2270. https://doi.org/10.1200/JCO.2015.64.8162
Check, Devon K., Cleo A. Samuel, Donald L. Rosenstein, and Stacie B. Dusetzina. “Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer.J Clin Oncol 34, no. 19 (July 1, 2016): 2265–70. https://doi.org/10.1200/JCO.2015.64.8162.
Check, Devon K., et al. “Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer.J Clin Oncol, vol. 34, no. 19, July 2016, pp. 2265–70. Pubmed, doi:10.1200/JCO.2015.64.8162.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

July 1, 2016

Volume

34

Issue

19

Start / End Page

2265 / 2270

Location

United States

Related Subject Headings

  • White People
  • United States
  • Terminal Care
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Medicare
  • Humans
  • Healthcare Disparities
  • Female
  • Breast Neoplasms