Image of C. Jillian Tsai, M.D., Ph.D.,; Image credit- Memorial Sloan Kettering Cancer Center
C. Jillian Tsai, M.D., Ph.D.,; Image credit: Memorial Sloan Kettering Cancer Center

At the end of life, Medicare and Medicaid recipients and people from racial and ethnic minority groups are more likely to receive low-value, aggressive cancer interventions, a new study has found.

Investigators examined health records of more than 21,000 patients with metastatic cancer (cancer which has spread from the initial site). They found that people of Black and Asian or Pacific Islander race, Hispanic ethnicity, with public insurance status, and who were admitted to an urban teaching hospital were more likely to receive this suboptimal care.

Together with the results of past studies, the current findings suggest that several clinical care factors are associated with disparities in end-of-life inpatient care management, wrote C. Jillian Tsai, M.D., Ph.D., of the Memorial Sloan Kettering Cancer Center, New York. These include patient-practitioner communication, cultural preferences, access to care and other systemic factors, including biases, she reported.

What’s more, the higher rate of low-value end-of-life care among Medicare or Medicaid recipients when compared with private insurance recipients suggests a national pattern among patients hospitalized with metastatic cancer, Tsai and colleagues wrote.

Previous studies have noted that Medicare beneficiaries in the general population are subject to high rates of intensive care, low rates of routine goals-of-care discussions, and low rates of hospice. Hospital inpatient care accounts for a large portion of Medicare spending, and similar patterns have been found among Medicaid beneficiaries — with even lower rates of hospice use, the authors noted.

“These results highlight an unmet need for improved quality and equity of end-of-life care among patients with metastatic cancer who receive care management in the inpatient setting,” they concluded.

Full findings were published Wednesday in JAMA Network Open.