But it’s also possible that patients who received more aggressive care were receiving the treatments they wanted, said Lee, who is also a transplant physician at Seattle Cancer Care Alliance. The study couldn’t address that question — the information wasn’t captured in patients’ medical records.
There could be cultural differences between whites and racial minorities that led to certain groups requesting more aggressive care than others, she said. The study was not large enough to examine differences between individual racial or ethnic minority groups — it only compared non-Hispanic whites to all racial minorities.
Additionally, it’s much harder for doctors to predict whether a patient with blood cancer will die than it is for a patient with a solid tumor cancer such as breast or lung cancer, Lee said. It’s possible that many of the patients in the study, no matter their race, simply didn’t know their cancers were terminal — and their doctors might not have known either.
There have been hints from previous studies, however, that racial minority patients aren’t using end-of-life or palliative care services as much as non-Hispanic white patients. It’s not always clear whether their care providers are less likely to offer these services to minority patients or if the patients are turning down the services, Kirtane said.
But if it turns out that the services aren’t being offered as frequently, and if that holds true among blood cancer patients as well, that’s a problem, Lee said.
“For anyone with a critical illness, having these conversations early and sensitively, over time, is important,” she said.
Such conversations about prognosis, death and the patients’ wishes should happen in the oncologist’s office, not the hospital in an emergency situation, Kirtane said. He believes that if the disparities hold true in a larger study, any changes to address those disparities may need to start in the clinic, and much earlier than the last month of the patients’ lives.
“As physicians, we always want to respect people’s preferences, especially at the end of life,” he said. “Those discussions should primarily be held in the outpatient setting. The worst thing is if someone is admitted to the hospital and then you’re having this discussion about what you want to do at the end of life when you might be there already.”
The National Institutes of Health and the Cambia Health Foundation funded this study.