Lack of awareness, cultural beliefs, and physician preferences may influence whether minority patients receive palliative care during metastatic breast cancer treatment.
Non-Hispanic Black, Hispanic, Asian or Pacific Islander patients with metastatic breast cancer were found to be less likely to receive palliative care than non-Hispanic White patients, according to study results that were presented at the 2023 American Association for Cancer Research conference. There has been a steady increase in utilization of palliative care from 2004 to 2020.
When implemented into a patient’s treatment, palliative care, which consists of treatments or procedures that aim to relieve pain as well as other adverse effects (AEs) because of cancer or cancer therapy, has the potential to improve mood, quality of life, and overall survival. The guidelines for palliative care require patients with cancer to be screened to define their palliative care needs both at intake and throughout treatment. Patients as well as their families or caregivers should be informed that palliative care is an essential part of their treatment.
“It is essential to identify the needs of these patients, particularly racial/ethnic minority populations, and evaluate how oncology programs can integrate palliative care early into the cancer care continuum while ensuring equitable access,” said study presenter Jincong Freeman, MPH, MS, a doctoral student in the department of public health sciences at the University of Chicago, in a press release.
To assess how palliative care use in the United States has changed over time for patients with metastatic breast cancer and better understand potential disparities, the study authors analyzed data from the National Cancer Database (NCDB) to examine differences in the utilization of palliative care between racial and ethnic groups. A total of 148,931 patients across 1500 cancer treatment centers were evaluated, and the results demonstrated that palliative care use increased over time from 2004 (14.9%) to 2020 (27.6%); however, compared to non-Hispanic White patients after adjusting for clinical and sociodemographic factors, non-Hispanic Black, Asian or Pacific Islander, and Hispanic patients were less likely to receive palliative care as part of treatment (13%, 26%, and 35%, respectively). Further, there was no significant difference in palliative care use between non-Hispanic White patients and patients who identified as American Indian, Alaska Native, or other.
Despite the increase, the study authors noted that palliative care use generally remained suboptimal, with over 70% of patients not receiving palliative care in 2020. Further, Freeman notes that the lack of awareness, cultural beliefs, and physician preferences may influence the opportunity for patients to receive palliative care. To further increase the uptake of palliative care across different populations, Freeman suggests that palliative care should be integrated early during cancer care continuum for all patients and misconceptions surrounding palliative care (eg, confusing palliative care with hospice care, assuming palliative care cannot be combined with active cancer treatment) should be addressed directly with the patient.
“Our findings underscore the importance of promoting the benefits of palliative care and addressing racial [and] ethnic disparities to improve the quality of life of [patients with metastatic breast cancer],” said Freeman in the press release.
Study limitations include the potential underreporting or misclassifications of palliative care in the NCDB, and adjustments made for clinical and sociodemographic factors. Further, the researchers did not have information on other factors (eg, patients’ symptoms and AEs because of treatment) that could determine whether palliative care is necessary for each individual patient.
American Association for Cancer Research. Racial/Ethnic Minority Patients May Be Less Likely Than White Patients to Receive Palliative Care During Breast Cancer Treatment. News release. September 29, 2023. Accessed October 2, 2023.