Predictors of aggressive end-of-life care among Hispanic and white advanced cancer patients

Abstract

9538 Background: Some ethnic/racial minority cancer patients (e.g. African Americans) have been shown to receive more life-prolonging care at the end-of-life (EOL) than white patients. Nevertheless, few studies have investigated whether Hispanic cancer patients receive more aggressive care than white patients and limited information exists on the predictors of aggressive care among Hispanic patients. The present study examined rates and predictors of aggressive EOL care among Hispanic and white cancer patients. Methods: Subjects participated in a US multi-site, prospective study between September 2002 - August 2008. Data were derived from interviews, conducted in English or Spanish, of 292 self-reported Hispanic (N=58) or white (N=234) stage IV cancer patients and their caregivers. Patients were followed until death, a median of 118.5 days later. Caregiver post-mortem interviews documented patient care in the last week of life. “Aggressive EOL care” was operationalized as cardiopulmonary resuscitation and/or ventilation and death in an intensive care unit. Aggressive EOL care was regressed on the following baseline, patient-reported, independent variables: a preference for life-prolonging care, EOL treatment discussion, do-not-resuscitate (DNR) order, terminal illness acknowledgement, and religious coping. Logistic regression models were stratified by ethnic status and controlled for significant confounds (e.g. socioeconomic status). Results: Hispanic and white advanced cancer patients were equally likely to receive aggressive EOL care (5.2% and 3.4%, respectively; p=0.878). Although religious coping and treatment preferences predicted aggressive EOL care for white patients (adjusted odds ratio 7.76 [p=0.025] and 13.20 [p=0.008]), they were not predictive among Hispanic patients. Hispanic patients were less likely than white patients to have DNR orders (22.4% vs 50.4%; p=0.007). For both white and Hispanic cancer patients, no patient who reported an EOL discussion or DNR order at baseline received aggressive EOL care. Conclusions: Given that EOL discussions and DNR orders may prevent aggressive EOL care among Hispanic cancer patients, further efforts to engage Hispanic patients and their caregivers in these activities may reduce aggressive EOL care. No significant financial relationships to disclose.