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Published in: Journal of Gastrointestinal Surgery 1/2021

01-01-2021 | Pancreatectomy | Original Article

Racial/Ethnic Disparities in Hospice Utilization Among Medicare Beneficiaries Dying from Pancreatic Cancer

Authors: Anghela Z. Paredes, J. Madison Hyer, Elizabeth Palmer, Maryam B. Lustberg, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 1/2021

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Abstract

Background

We sought to define the incidence and characterize the timing of hospice utilization among racial/ethnic minority patients following pancreatectomy for pancreatic cancer.

Methods

The Medicare Standard Analytic Files from 2013 to 2017 were used to identify patients with pancreatic cancer who underwent a pancreatectomy. Logistic regression was utilized to identify the association between race and patterns of hospice utilization among deceased individuals.

Results

Among the 14,495 individuals (median age 73; 52.3% female; 6.8% racial/ethnic minority) who underwent a pancreatectomy for pancreatic cancer, 47% (n = 6859) died by the end of the follow-period. Among deceased individuals, three-fourths of patients (n = 4978, 72.6%) used hospice leading up to the time of death. Racial/ethnic minority patients were less likely, however, to have used hospice services compared with white patients (racial/ethnic minorities n = 301, 67% vs. whites: n = 4677, 73%; p = 0.024). On multivariable analysis, after controlling for clinical factors, racial/ethnic minority patients remained 22% less likely than whites to initiate hospice services prior to death (OR 0.78, 95% CI 0.63–0.96). Despite overall lower use of hospice, racial/ethnic minority patients had comparable odds of late hospice utilization (i.e., within 3 days of death) versus white patients (OR 1.5, 95% CI 0.73–1.50).

Discussion

While most patients undergoing pancreatectomy for pancreatic cancer utilized hospice services prior to death, racial/ethnic minorities were less likely to use hospice services than whites.
Literature
1.
go back to reference Tavakkoli A, Singal AG, Waljee AK, et al. Racial Disparities and Trends in Pancreatic Cancer Incidence and Mortality in the United States. Clin Gastroenterol Hepatol. 2019. Tavakkoli A, Singal AG, Waljee AK, et al. Racial Disparities and Trends in Pancreatic Cancer Incidence and Mortality in the United States. Clin Gastroenterol Hepatol. 2019.
2.
go back to reference Wright MJ, Overton HN, Teinor JA, et al. Disparities in the Use of Chemotherapy in Patients with Resected Pancreatic Ductal Adenocarcinoma. J Gastrointest Surg. 2019. Wright MJ, Overton HN, Teinor JA, et al. Disparities in the Use of Chemotherapy in Patients with Resected Pancreatic Ductal Adenocarcinoma. J Gastrointest Surg. 2019.
3.
go back to reference Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7(2):525–535.CrossRef Nipp R, Tramontano AC, Kong CY, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7(2):525–535.CrossRef
4.
go back to reference Cheraghlou S, Gahbauer EA, Leo-Summers L, Stabenau HF, Chaudhry SI, Gill TM. Restricting Symptoms Before and After Admission to Hospice. Am J Med. 2016;129(7):754 e757–754 e715.CrossRef Cheraghlou S, Gahbauer EA, Leo-Summers L, Stabenau HF, Chaudhry SI, Gill TM. Restricting Symptoms Before and After Admission to Hospice. Am J Med. 2016;129(7):754 e757–754 e715.CrossRef
6.
go back to reference Paredes AZ, Hyer JM, Tsilimigras DI, et al. Hospice utilization among Medicare beneficiaries dying from pancreatic cancer. J Surg Oncol. 2019;120(4):624–631.PubMed Paredes AZ, Hyer JM, Tsilimigras DI, et al. Hospice utilization among Medicare beneficiaries dying from pancreatic cancer. J Surg Oncol. 2019;120(4):624–631.PubMed
7.
go back to reference Taylor JS, Rajan SS, Zhang N, et al. End-of-Life Racial and Ethnic Disparities Among Patients With Ovarian Cancer. J Clin Oncol. 2017;35(16):1829–1835.CrossRef Taylor JS, Rajan SS, Zhang N, et al. End-of-Life Racial and Ethnic Disparities Among Patients With Ovarian Cancer. J Clin Oncol. 2017;35(16):1829–1835.CrossRef
8.
go back to reference Rush B, Hertz P, Bond A, McDermid RC, Celi LA. Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States. Chest. 2017;151(1):41–46.CrossRef Rush B, Hertz P, Bond A, McDermid RC, Celi LA. Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States. Chest. 2017;151(1):41–46.CrossRef
9.
go back to reference Ferris FD, Bruera E, Cherny N, et al. Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology. J Clin Oncol. 2009;27(18):3052–3058.CrossRef Ferris FD, Bruera E, Cherny N, et al. Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology. J Clin Oncol. 2009;27(18):3052–3058.CrossRef
10.
go back to reference Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–682.CrossRef Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–682.CrossRef
11.
go back to reference Iezzoni LI, Daley J, Heeren T, et al. Using administrative data to screen hospitals for high complication rates. Inquiry. 1994;31(1):40–55.PubMed Iezzoni LI, Daley J, Heeren T, et al. Using administrative data to screen hospitals for high complication rates. Inquiry. 1994;31(1):40–55.PubMed
12.
go back to reference Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32(7):700–715.CrossRef Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32(7):700–715.CrossRef
13.
go back to reference Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504.CrossRef Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504.CrossRef
14.
go back to reference Fairfield KM, Murray KM, Wierman HR, et al. Disparities in hospice care among older women dying with ovarian cancer. Gynecol Oncol. 2012;125(1):14–18.CrossRef Fairfield KM, Murray KM, Wierman HR, et al. Disparities in hospice care among older women dying with ovarian cancer. Gynecol Oncol. 2012;125(1):14–18.CrossRef
15.
go back to reference Enomoto LM, Schaefer EW, Goldenberg D, Mackley H, Koch WM, Hollenbeak CS. The Cost of Hospice Services in Terminally Ill Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1066–1074.CrossRef Enomoto LM, Schaefer EW, Goldenberg D, Mackley H, Koch WM, Hollenbeak CS. The Cost of Hospice Services in Terminally Ill Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1066–1074.CrossRef
16.
go back to reference Wachterman MW, Hailpern SM, Keating NL, Kurella Tamura M, O'Hare AM. Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis. JAMA Intern Med. 2018;178(6):792–799.CrossRef Wachterman MW, Hailpern SM, Keating NL, Kurella Tamura M, O'Hare AM. Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis. JAMA Intern Med. 2018;178(6):792–799.CrossRef
17.
go back to reference Zou WY, El-Serag HB, Sada YH, et al. Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population. Dig Dis Sci. 2018;63(5):1173–1181.CrossRef Zou WY, El-Serag HB, Sada YH, et al. Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population. Dig Dis Sci. 2018;63(5):1173–1181.CrossRef
18.
go back to reference Kim A, Ashman P, Ward-Peterson M, Lozano JM, Barengo NC. Racial disparities in cancer-related survival in patients with squamous cell carcinoma of the esophagus in the US between 1973 and 2013. PLoS One. 2017;12(8):e0183782.CrossRef Kim A, Ashman P, Ward-Peterson M, Lozano JM, Barengo NC. Racial disparities in cancer-related survival in patients with squamous cell carcinoma of the esophagus in the US between 1973 and 2013. PLoS One. 2017;12(8):e0183782.CrossRef
19.
go back to reference Bregar AJ, Alejandro Rauh-Hain J, Spencer R, et al. Disparities in receipt of care for high-grade endometrial cancer: A National Cancer Data Base analysis. Gynecol Oncol. 2017;145(1):114–121.CrossRef Bregar AJ, Alejandro Rauh-Hain J, Spencer R, et al. Disparities in receipt of care for high-grade endometrial cancer: A National Cancer Data Base analysis. Gynecol Oncol. 2017;145(1):114–121.CrossRef
20.
go back to reference Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Gomez SL. Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics. J Clin Oncol. 2018;36(1):25–33.CrossRef Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Gomez SL. Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics. J Clin Oncol. 2018;36(1):25–33.CrossRef
21.
go back to reference Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jimenez-Fonseca P, Peiro I, Carrato A. Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol. 2017;19(11):1293–1302.CrossRef Laquente B, Calsina-Berna A, Carmona-Bayonas A, Jimenez-Fonseca P, Peiro I, Carrato A. Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol. 2017;19(11):1293–1302.CrossRef
22.
go back to reference Sheffield KM, Crowell KT, Lin YL, Djukom C, Goodwin JS, Riall TS. Surveillance of pancreatic cancer patients after surgical resection. Ann Surg Oncol. 2012;19(5):1670–1677.CrossRef Sheffield KM, Crowell KT, Lin YL, Djukom C, Goodwin JS, Riall TS. Surveillance of pancreatic cancer patients after surgical resection. Ann Surg Oncol. 2012;19(5):1670–1677.CrossRef
23.
go back to reference Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists : challenges to assuring access to oncology services. J Oncol Pract. 2007;3(2):79–86.CrossRef Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists : challenges to assuring access to oncology services. J Oncol Pract. 2007;3(2):79–86.CrossRef
24.
go back to reference Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in self-reported exposure to information about hospice care. J Palliat Med. 2009;12(10):921–927.CrossRef Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in self-reported exposure to information about hospice care. J Palliat Med. 2009;12(10):921–927.CrossRef
25.
go back to reference Kreling B, Selsky C, Perret-Gentil M, Huerta EE, Mandelblatt JS, Latin American Cancer Research C. 'The worst thing about hospice is that they talk about death': contrasting hospice decisions and experience among immigrant Central and South American Latinos with US-born White, non-Latino cancer caregivers. Palliat Med. 2010;24(4):427–434.CrossRef Kreling B, Selsky C, Perret-Gentil M, Huerta EE, Mandelblatt JS, Latin American Cancer Research C. 'The worst thing about hospice is that they talk about death': contrasting hospice decisions and experience among immigrant Central and South American Latinos with US-born White, non-Latino cancer caregivers. Palliat Med. 2010;24(4):427–434.CrossRef
26.
go back to reference Smith AK, Sudore RL, Perez-Stable EJ. Palliative care for Latino patients and their families: whenever we prayed, she wept. JAMA. 2009;301(10):1047–1057, E1041.CrossRef Smith AK, Sudore RL, Perez-Stable EJ. Palliative care for Latino patients and their families: whenever we prayed, she wept. JAMA. 2009;301(10):1047–1057, E1041.CrossRef
27.
go back to reference Cicolello K, Anandarajah G. Multiple Stakeholders' Perspectives Regarding Barriers to Hospice Enrollment in Diverse Patient Populations: A Qualitative Study. J Pain Symptom Manage. 2019;57(5):869–879.CrossRef Cicolello K, Anandarajah G. Multiple Stakeholders' Perspectives Regarding Barriers to Hospice Enrollment in Diverse Patient Populations: A Qualitative Study. J Pain Symptom Manage. 2019;57(5):869–879.CrossRef
28.
go back to reference Rickerson E, Harrold J, Kapo J, Carroll JT, Casarett D. Timing of hospice referral and families' perceptions of services: are earlier hospice referrals better? J Am Geriatr Soc. 2005;53(5):819–823.CrossRef Rickerson E, Harrold J, Kapo J, Carroll JT, Casarett D. Timing of hospice referral and families' perceptions of services: are earlier hospice referrals better? J Am Geriatr Soc. 2005;53(5):819–823.CrossRef
29.
go back to reference Dover LL, Dulaney CR, Williams CP, et al. Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors. Neuro Oncol. 2018;20(7):986–993.CrossRef Dover LL, Dulaney CR, Williams CP, et al. Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors. Neuro Oncol. 2018;20(7):986–993.CrossRef
30.
go back to reference Zuckerman RB, Stearns SC, Sheingold SH. Hospice Use, Hospitalization, and Medicare Spending at the End of Life. J Gerontol B Psychol Sci Soc Sci. 2016;71(3):569–580.CrossRef Zuckerman RB, Stearns SC, Sheingold SH. Hospice Use, Hospitalization, and Medicare Spending at the End of Life. J Gerontol B Psychol Sci Soc Sci. 2016;71(3):569–580.CrossRef
31.
go back to reference Adams CE, Bader J, Horn KV. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services. Home Health Care Manag Pract. 2009;21(2):109–116.CrossRef Adams CE, Bader J, Horn KV. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services. Home Health Care Manag Pract. 2009;21(2):109–116.CrossRef
32.
go back to reference Ramchandran K, Tribett E, Dietrich B, Von Roenn J. Integrating Palliative Care Into Oncology: A Way Forward. Cancer Control. 2015;22(4):386–395.CrossRef Ramchandran K, Tribett E, Dietrich B, Von Roenn J. Integrating Palliative Care Into Oncology: A Way Forward. Cancer Control. 2015;22(4):386–395.CrossRef
33.
go back to reference Elsayem A, Swint K, Fisch MJ, et al. Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol. 2004;22(10):2008–2014.CrossRef Elsayem A, Swint K, Fisch MJ, et al. Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol. 2004;22(10):2008–2014.CrossRef
Metadata
Title
Racial/Ethnic Disparities in Hospice Utilization Among Medicare Beneficiaries Dying from Pancreatic Cancer
Authors
Anghela Z. Paredes
J. Madison Hyer
Elizabeth Palmer
Maryam B. Lustberg
Timothy M. Pawlik
Publication date
01-01-2021
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2021
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-020-04568-9

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