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Trends and racial disparities in aggressive end-of-life care for a national sample of women with ovarian cancer.

Authors
  • Mullins, Megan A1
  • Ruterbusch, Julie J2
  • Clarke, Philippa3
  • Uppal, Shitanshu4
  • Wallner, Lauren P5
  • Cote, Michele L2
  • 1 Center for Improving Patient and Population Health and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
  • 2 Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan.
  • 3 Department of Epidemiology and Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
  • 4 Department of Gynecologic Oncology, University of Michigan, Ann Arbor, Michigan.
  • 5 Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Type
Published Article
Journal
Cancer
Publisher
Wiley (John Wiley & Sons)
Publication Date
Jul 01, 2021
Volume
127
Issue
13
Pages
2229–2237
Identifiers
DOI: 10.1002/cncr.33488
PMID: 33631053
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The clinical landscape has moved toward less aggressive end-of-life care for women with ovarian cancer. However, whether there has been a decline in the use of aggressive end-of-life services is unknown. The authors evaluated current national trends and racial disparities in end-of-life care among women with ovarian cancer using the Surveillance, Epidemiology, and End Results-Medicare-linked data set. In total, 7756 Medicare beneficiaries aged >66 years with ovarian cancer who died between 2007 and 2016 were identified. The authors examined trends and racial disparities in late hospice or no hospice use, >1 emergency department (ED) visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life-extending procedures using multivariable logistic regression. The median hospice length of stay did not change over time; however, women were increasingly admitted to the intensive care unit and had multiple ED visits in the last month of life (P < .001). Not enrolling in hospice at the end of life and terminal hospitalizations decreased over time (P < .001). Non-White women were more likely to receive aggressive end-of-life care, particularly for hospital-related utilization and life-extending procedures, whereas non-Hispanic Black women were more likely to have >1 ED visit (odds ratio, 2.04; 95% CI, 1.57-2.64) or life-extending procedures (odds ratio, 1.89; 95% CI, 1.45-2.48) compared with non-Hispanic White women. Despite clinical guidelines and increasing emphasis on reducing aggressive end-of-life care, the use of aggressive end-of-life care for women with ovarian cancer persists, and care is most aggressive for non-White women. © 2021 American Cancer Society.

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