For Patients with Cancer, Race Is Associated with Preferences for EOL Care

A study found that non-white patients with cancer were more likely to prefer aggressive end of life (EOL) care compared with white patients. These findings were published in Supportive Care in Cancer.

“Non-white [patients with] cancer receive more aggressive care at the EOL. This may indicate low quality EOL care if discordant with patient preferences,” wrote the study authors. “We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas [patients with] cancer.”

For this analysis, the investigators retrospectively reviewed a population-based convenience sample of patients diagnosed with cancer between March 2018 and June 2020, via the Texas Cancer Registry. EOL preference variables included location of death and use of mechanical ventilation. To examine the association between covariates, the team utilized an inverse probability weighting analysis to construct multivariable logistic regression.

In total, 1,460 patients were evaluated. A majority (82%) reported a preference to die at their homes, whereas 8% preferred to die at the hospital. A quarter of respondents preferred undergoing mechanical ventilation at EOL.

Analysis showed that Black patients expressed an increased preference for in-hospital death (odds ratio [OR]=1.81; 95% confidence interval, 1.19-2.73) compared to white patients. Patients of other non-white, non-Hispanic race also had an increased preference for in-hospital death (OR=3.53; 95% CI, 1.99-6.27).

Male patients, patients who are married, and those with higher education demonstrated a significantly higher preference for at-home death. Non-white patients of all races more frequently reported a preference for mechanical ventilation at EOL compared to white patients. Patients who lived with another person at home were also more likely to prefer ventilation.

In conclusion, the authors wrote, “Non-white cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.”