A new study suggested that black patients with cancer are less hesitant to spend all their financial resources on treatments that prolong life than white patients with cancer. The data also showed that Asian and Hispanic patients with cancer are more amenable than whites to the prospect of exhausting their funds to survive longer but less amenable than blacks.
Michelle Martin, PhD, with the University of Alabama at Birmingham, and colleagues compared the willingness to expend all financial resources to extend life in 4214 white, black, Hispanic, and Asian patients with cancer. Subjects were drawn from the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, which is a population-, healthcare-, and system-based observational cohort study of 10,000 patients with newly diagnosed lung or colorectal cancer.
While minority patients receive more intensive interventions at the end of life, it has not been known whether aggressive end-of-life care reflects their treatment preference, commented Martin and associates. Research to date has focused largely on documenting preferences for lifeprolonging treatment for different racial and ethnic groups while ignoring potential trade-offs that accrue from treatment decisions. They added that understanding treatment preferences and whether they are in sync with the care that is actually delivered is requisite for delivering patient-centered care.
Overall, 80% of blacks cited a willingness to spend all resources to receive life-prolonging care compared with 54% of whites, 69% of Hispanics, and 72% of Asians (P
<.001). On multivariate analysis, blacks were more likely than whites to voice a preference for expending resources to extend life (adjusted odds ratio [OR] = 2.41; 95% confidence interval, 1.84-3.17; P
<.001). The difference between the willingness of black and white patients with cancer to exhaust available personal resources was not due to patients’ age, education, income, health insurance status, medical comorbidity, stage at diagnosis, marital status, level of social support, fatalism, or perceived time left to live.
The adjusted OR for Hispanics versus whites was 1.45 (95% CI, 1.02-2.08; P
<.001), while the adjusted OR for Asians versus whites was 1.59 (95% CI, 1.02-2.48; P
The study included a racially and ethnically diverse population of patients with cancer from all over the United States.
Importantly, the study included a racially and ethnically diverse population of patients with cancer from all over the United States; this adds to earlier preference studies that included mostly black and white patients with cancer or patients with cancer from a single site, said Martin and team. Also, because of the detailed information available in the CanCORS database, the researchers were able to control for more potentially confounding factors than earlier studies.
On the other hand, the authors cautioned that the study lacked detailed information on patients’ trust in the healthcare system, their experiences of discrimination, and religiosity, all of which may have influenced their preferences. In addition, the study did not examine whether actual treatment decisions were based on patient preferences.
Martin and associates said that future research should examine how findings from the present study may influence other components of patient care. For example, patients who are willing to use their personal resources to possibly extend life may also be willing to enroll in a clinical study and receive potentially useful investigational treatments.
Martin MY, Pisu M, Oster RA, et al. Racial variation in willingness to trade financial resources for life-prolonging cancer treatment [published online ahead of print April 26 2011]. Cancer. doi: 10.1002/ cncr.25839.