How much palliative care breast cancer patients get may depend on race

When women have advanced breast cancer, the amount of comfort-oriented care they receive at the end of life may depend on the color of their skin, a small U.S. study suggests.

Researchers examined data from Medicare, the U.S. government health program for the elderly, for 752 white and 131 black patients with final-stage breast cancer who died from 2007 to 2012. Black women were 49 percent less likely to receive certain medications for symptom relief than white patients, and they were also 14 percent less likely to get hospice care aimed at improving quality of life in their final days, the study found.

At the same time, black women were 28 percent more likely than white women to have emergency department visits or hospitalizations in their last month of life, and they were also 59 percent more likely to die in the hospital.

"Unfortunately, we found potential disparities in the use of supportive medications for treatment of common symptoms of cancer, namely, depression, anxiety, and insomnia," said lead study author Devon Check, a public health researcher at the University of North Carolina, Chapel Hill.

To assess racial disparities in end-of-life breast cancer care, Check and colleagues focused on the drugs women received in the three months after their diagnosis as well as the types of medical treatment they had in their final month of life.

Their hypothesis was that differences in the types of medical treatments women received at the end of life might be influenced by the number of medications women initially received.

Even though the study didn't find a relationship between these two aspects of cancer care, black women's lack of access to supportive medications relative to white women still points to disparities that need to be addressed, Check said by email.

"Disparities in supportive medication use are concerning as they could point to inadequate symptom management and reduced quality of life," Check said. "It is important for patients and providers to communicate about supportive care needs and preferences – for example, surrounding symptoms of anxiety, depression, insomnia and pain – to alleviate patient distress and suffering."

Black women in the study tended to have more diseases in addition to cancer than the white women, and they were also more likely to be single and have a lower socioeconomic status.

The women ranged in age from 65 years old into their 80s, but a larger proportion of the black women were on the younger end of this spectrum. One third of black women were diagnosed between ages 65 and 70, while 30 percent of white women were diagnosed at age 83 or older.

All of the women had similar patterns of cancer therapy and comparable use of powerful opiate painkillers, researchers report in the Journal of Clinical Oncology. But just 13 percent of black women got psychotropic drugs designed to improve their mood and ease anxiety, compared with 23 percent of white women.

One limitation of the study is that it focused only on women with what's known as fee-for-service Medicare, which might influence their cost and access to care and make the results hard to apply to women with different insurance, the authors note. They also may not have had complete data on some aspects of supportive care such as counseling.

It's also possible that differences in financial resources among patients could have contributed to the disparities in treatment and differences in outcomes, said Dr. Sharon Giordano, chair of health services research at The University of Texas MD Anderson Cancer Center in Houston.

"Those patients who had limited financial resources could have been less able to pay for medications, including medications that were prescribed to help with symptom control," Giordano, who wasn't involved in the study, said by email. At the same time, the findings add to a growing body of evidence suggesting that race plays a role in how cancer patients get treated.

"Other studies have found that patients who enroll in hospice have better quality of life and longer survival," Giordano said. "One could hypothesize that the patients who have good control of their symptoms are more comfortable having their care managed at home through a hospice program."