Presentation Authors: Alexander Putnam Cole*, Akezhan Meirkhanov, Sean Anthony Fletcher, Zara Cooper, Stuart R. Lipsitz, Joel S. Weissmann, Kerry L. Kilbridge, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA
Introduction: There is evidence that members of racial and ethnic minority groups may be less likely to receive palliative care compared to non-Hispanic Whites. This may be due to either to different treatment of minority patients by physicians, or from less utilization of palliative care at the relatively small number of hospitals which treat a large portion of minority patients. To assess the impact of site of care on disparities in palliative care, we assessed whether receipt of palliative care among men with metastatic prostate cancer differed at hospitals which predominantly treat minority patients.
Methods: We abstracted data on men >40 years of age, with metastatic prostate cancer within the National Cancer Database. The receipt of palliative care was compared in each racial group. Hospitals in the top decile in terms of the proportion of Black and Hispanic patients were defined as minority-serving hospitals (MSHs). A multilevel logistic regression model estimating the odds of receiving palliative care based on MSH status was fit, adjusting for year of diagnosis, sex, race, insurance, income, and education, with a hospital-level random intercept to account for unmeasured hospital characteristics.
Results: Our study cohort consisted of 44,521 men with metastatic prostate cancer. The average age was 71.3 (95% CI 71.1-71.6). Of these men, 7096 (15.9%) were treated at MSHs. The proportion of men of receiving palliative care differed based on race: Overall 15.9% of white men received palliative care for prostate cancer, whereas only 14.7% of black men and 12.0% of Hispanics received palliative care (p < 0.001). In our model adjusting for clinical and demographic variables, and minority serving hospital status, MSH status had a large and statistically significant association with lower odds of palliative care (OR 0.67 95% CI 0.55-0.82), whereas Black and Hispanic race did not (OR 1.00 95% 0.91-1.09) and (0.98 95% 0.85-1.13).
Conclusions: In our adjusted model, treatment at an MSH had a large and statistically significant impact on receipt of palliative care; patient race did not. These findings suggest that the site of care, may account for much of the observed race-based disparities in palliative care in prostate cancer. Targeting MSHs may represent an effective strategy to combat disparities in palliative care.
Source of Funding: Brigham Research Institute, Bruce A. Beal and Robert L. Beal Surgical Fellowship, Conquer Cancer Foundation, Defense Health Agency, Intuitive Surgical, Prostate Cancer Foundation, Vattikuti Urology Institute.