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2019 ASCO Annual Meeting!


Session: Health Services Research, Clinical Informatics, and Quality of Care

Type: Oral Abstract Session

Time: Friday May 31, 2:45 PM to 5:45 PM

Location: S102

Quality of end-of-life cancer care at minority-serving US cancer centers: A retrospective study of Medicare claims data.

Sub-category:
Disparities/Access to Care

Category:
Health Services Research, Clinical Informatics, and Quality of Care

Meeting:
2019 ASCO Annual Meeting

Abstract No:
6507

Citation:
J Clin Oncol 37, 2019 (suppl; abstr 6507)

Author(s): Garrett Wasp, Shama S Alam, Gabriel A. Brooks, Inas S Khayal, Nirav S. Kapadia, Donald Q Carmicheal, Andrea M Austin, Amber Barnato; Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH; Dana-Farber Cancer Institute, Boston, MA; Dartmouth-Hitchcock Medical Center, Cornish, NH; Dartmouth College, Hanover, NH

Abstract Disclosures

Abstract:

Background: Higher EOL treatment intensity is burdensome and has been defined as low-quality care. We explored cancer centers’ EOL quality outcomes among minority and white patients and evaluated whether minority-serving cancer centers had systematically lower EOL quality. Methods: We conducted a retrospective cohort study of Medicare beneficiaries with poor-prognosis cancers who died between April 1, 2016 and December 31 2016. We attributed patients’ EOL treatment to the cancer center where they received the preponderance of inpatient services during the last 6 months of life. We then compared age-sex-comorbidity adjusted center-level measures of EOL care (EOL chemotherapy, emergency department (ED) use, intensive care unit (ICU) admission, hospice use, life-sustaining treatment use, palliative care, and advance care planning) between minority (black, Hispanic, Asian, other) and non-Hispanic white (white) patients within the same center and across centers, grouped by concentration of minorities served (low: < 15%, medium 15-30%, and high > 30%). Results: Among 126,434 patients, 10,006 (21.4% minority) received treatment at one of 53 National Cancer Institute-designated and/or National Comprehensive Cancer Network-affiliated cancer centers. Only 4/8 quality measures had sufficient sample size to calculate a minority-specific rate for ≥10 centers. Those measures showed high within-center correlation for minority and white patients (ICU admission: r = 0.79,p < 0.001; no hospice referral: r = 0.70,p < 0.0001; life sustaining treatment: r = 0.73,p = 0.004; and palliative care: r = 0.78,p < 0.0001), but the mean adjusted rate for minority versus white patients was significantly worse for two measures: no hospice referral (40.2% v. 37.2%; p < 0.02) and life-sustaining treatments (21.8% v. 19.4%; p < 0.02). When grouped by concentration of minorities served (low/medium/high), 5/8 measures showed systematically lower quality as the concentration of minorities increased: more than 1 ED visit (6.0/8.5/7.7%; p = 0.002), ICU admission (29.1/29.7/35.1%; p = 0.0004), no hospice referral (34.3/38.7/36.8% (p = 0.005), and life sustaining treatments (14.8/16.7/17.9%; p = 0.005). Conclusions: There were systematic differences in end-of-life quality measures across US cancer centers. For many measures, quality was lower at centers that served a greater concentration of minorities. However, EOL care quality for minority and white patients was similar for most but not all measures within any given center.

 
Other Abstracts in this Sub-Category:

 

1. Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

Meeting: 2019 ASCO Annual Meeting Abstract No: LBA1 First Author: Blythe J.S. Adamson
Category: Health Services Research, Clinical Informatics, and Quality of Care - Disparities/Access to Care

 

2. The Affordable Care Act and cost-related medication non-compliance in cancer survivors.

Meeting: 2019 ASCO Annual Meeting Abstract No: 106 First Author: Justin Barnes
Category: Health Services Research, Clinical Informatics, and Quality of Care - Disparities/Access to Care

 

3. Impact of broadening clinical trial eligibility criteria for advanced non-small cell lung cancer patients: Real-world analysis.

Meeting: 2019 ASCO Annual Meeting Abstract No: LBA108 First Author: R. Donald Harvey
Category: Health Services Research, Clinical Informatics, and Quality of Care - Disparities/Access to Care

 

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