Comparing the use and quality of palliative and end-of-life care between Asian and non-Asian patients with cancer.

Abstract

e13765 Background: Palliative care (PC) is associated with improved outcomes in patients with cancer. The term Asian-American refers to various cultures and ethnicities and is the fastest growing minority in the US. Literature suggests Asians receive more intense care at end of life. A small study conducted at the same medical center, prior to the growth of PC services, found a higher rate of in-patient hospital and ICU deaths and greater use of mechanical ventilation in Asian patients (AP) with cancer compared with non-Asian patients (AP). Our goal was to quantify PC use and end-of-life quality (EOLQ) metrics in AP versus non-AP populations in a retrospective cohort study of hospitalized cancer patients. We predicted AP would have less PC use and lower EOLQ metrics. Methods: We identified deceased patients admitted to Tufts Medical Center’s oncology unit between 1/1/2019-12/1/2022. Demographics, admission statistics, inpatient/ outpatient PC visits, advance care planning (ACP), and EOLQ outcomes, including emergency department (ED) visits, hospitalization, and ICU stay within 30 days of death, were collected from the electronic medical record. Chi square and Fisher's exact tests were used to compare the differences between AP and non-AP regarding PC use and EOLQ metrics. Results: Of the 220 patients included in the study, 24% (n = 52) were AP. AP and non-AP did not differ in use of CPR (2% vs 3%, p = 1.0), ventilation (6% vs 9%, p = 0.57), ICU admission (19% vs 21%, p = 0.17), or PC consults (48% vs 53%, p = 0.53) during their last admission; nor in outpatient PC visits (53% vs 60%, p = 0.37) or first inpatient PC visit before last admission (27% vs 36%, p = 0.24). There was no significant difference in EOLQ within 30 days of death between the AP and non-AP group, specifically in ED visits (58% vs 58%, p = 0.94), hospitalization (58% vs 63%, p = 0.51), ICU stay (16% vs 21%, p = 0.37) and hospice enrollment (58% vs 68%, p = 0.71). Conclusions: In this retrospective study of hospitalized patients with cancer, AP patients had no significant differences in use of PC services or EOLQ metrics when compared to non-AP patients. These findings differ from our hypothesis and may reflect positive changes that correspond to the expansion of PC services and greater awareness or acceptance of PC. More work is needed to explore how PC might help reduce disparities between AP and non-AP.