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Study Reveals Inferior End-of-Life Treatment for Black Ovarian Cancer Patients

Non-Hispanic Black (NHB) individuals undergoing end-of-life (EOL) treatment tend to receive inferior care compared to non-Hispanic White (NHW) patients, as indicated by a study published in .

The study highlights the importance of top-notch EOL care, which encompasses enhanced symptom control, better quality of life, and significantly reduced healthcare expenses. Despite these benefits, a considerable number of patients do not experience this level of care, with racial inequalities in quality EOL care prevalent at both local and national levels.

While disparities in EOL care trends among patients with ovarian cancer (OC) are well-documented, the researchers emphasized the insufficient characterization of healthcare access (HCA) in ensuring quality EOL care. HCA involves five essential dimensions: affordability, availability, accessibility, accommodation, and acceptability.

To address this gap, the researchers aimed to explore the link between racial disparities in EOL care quality and three HCA domains—availability (in terms of type, quality, and quantity of healthcare resources), accessibility (proximity to healthcare resources), and affordability (financial capability to access healthcare)—among NHW, NHB, and Hispanic patients with OC.

To achieve this, the researchers conducted an analysis on women aged 65 years or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, diagnosed with OC between 2008 and 2015. These patients had to survive for at least 30 days post-diagnosis, with continuous Medicare fee-for-service (FFS) coverage from one year pre-diagnosis until death.

By utilizing confirmatory factor analysis (CFA), the researchers identified the most influential variables for each HCA aspect and generated composite scores ranging from -3 to 4 to depict the availability, accessibility, and affordability of high-quality EOL care for each patient.

Lower availability scores indicated fewer local hospitals and physicians, alongside lower hospital quality. Similarly, reduced accessibility scores suggested longer travel distances to healthcare facilities, while lower affordability scores pointed to areas with higher poverty rates or lower educational levels.

The study cohort comprised a total of 4646 OC patients, with a mean (standard deviation [SD]) age of 77.5 (7.0) years. This included 4061 (87.4%) NHW patients, 322 (6.9%) NHB patients, and 263 (5.7%) Hispanic patients, with the majority (N = 4176; 89.9%) diagnosed at stage III or IV OC.

The researchers observed that 42.9% of the patients were hospitalized in their final month of life, with a higher proportion of NHB patients (53.7%) compared to Hispanic (43.7%) and NHW (42.0%) patients. Furthermore, 30.9% of the cohort did not utilize hospice before death, with varying rates among NHW (30.1%), NHB (35.7%), and Hispanic (37.3%) patients. Notably, 19.05% of the population passed away in the hospital, with NHB (24.8%) and Hispanic (25.8%) patients constituting higher proportions than NHW patients (18.1%; P < .001). The study revealed that NHB and Hispanic patients with OC exhibited slightly elevated average instances of poor-quality EOL care outcomes (NHB mean count, 1.59; Hispanic, 1.46; NHW, 1.29; P < .001).

Additionally, the CFA outcomes indicated that higher affordability scores were linked to a 9% reduced risk of hospital deaths (adjusted relative risk [aRR], 0.91; 95% CI, 0.84-0.98) and a 10% decreased risk of ICU admission in the last 30 days of life (aRR, 0.90; 95% CI, 0.83-0.98). Patients with higher availability scores faced an 11% increased risk of hospital deaths (aRR, 11.11; 95% CI, 1.02-1.20) and a 7% elevated risk of hospitalization in the final 30 days of life (aRR, 1.07; 95% CI, 1.02-1.12). Conversely, higher accessibility scores were associated with a 54% reduced risk of two or more ER visits in the last 30 days of life (OR, 0.46; 95% CI, 0.35-0.62), a 12% decreased risk of not receiving hospice services before death (aRR, 0.88; 95% CI, 0.80-0.95), and a substantially increased risk of ICU admission (aRR, 1.35; 95% CI, 1.14-1.60).

After adjusting for HCA dimensions, the researchers found that NHB patients with OC faced a higher risk of common poor EOL care quality outcomes compared to NHW patients, with a 19% increase in poor-quality EOL outcomes (count ratio, 1.19; 95% CI, 1.04-1.36). Specifically, NHB patients with OC were at an elevated risk of hospitalization in the final 30 days of life (aRR, 1.16; 95% CI, 1.03-1.30), not receiving hospice care before death (aRR, 1.23; 95% CI, 1.04-1.44), and in-hospital deaths (aRR, 1.26; 95% CI, 1.03-1.57).

Acknowledging the study’s limitations, the researchers noted that the findings were based on patients aged 65 years or older, potentially limiting generalizability to younger cohorts. Moreover, the reported racial disparities in EOL care may reflect the study period (2008-2015). Despite these constraints, the researchers proposed avenues for future research based on their results.

“Investigations into accommodation and acceptability HCA dimensions can provide insights into underexplored barriers to high-quality EOL care,” the authors concluded. “Our findings underscore the necessity for strategies to standardize the delivery of supportive, palliative, and EOL care for terminally ill OC patients, regardless of race or ethnicity.”


Karanth S, Osazuwa-Peters OL, Wilson LE, et al. Health care access dimensions and racial disparities in end-of-life care quality among patients with ovarian cancer. Cancer Res Commun. 2024;4(3):811-821. doi:10.11582767-9764.CRC-23-0283