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Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives.
Shiovitz, Stacey; Bansal, Aasthaa; Burnett-Hartman, Andrea N; Karnopp, Andrew; Adams, Scott V; Warren-Mears, Victoria; Ramsey, Scott D.
Affiliation
  • Shiovitz S; University of Washington, Division of Oncology, Seattle, Washington. Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington. shiovitz@uw.edu.
  • Bansal A; University of Washington, Department of Pharmacy, Seattle, Washington.
  • Burnett-Hartman AN; Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington.
  • Karnopp A; Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington.
  • Adams SV; Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington.
  • Warren-Mears V; Northwest Portland Area Indian Health Board, Portland, Oregon.
  • Ramsey SD; University of Washington, Department of Pharmacy, Seattle, Washington. Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington. University of Washington, Division of General Medicine, Seattle, Washington.
Cancer Epidemiol Biomarkers Prev ; 24(7): 1138-43, 2015 Jul.
Article in En | MEDLINE | ID: mdl-25987547
BACKGROUND: Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer. METHODS: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care. RESULTS: AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83-1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61-0.99). CONCLUSION: Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted. IMPACT: Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Indians, North American / Registries / Population Surveillance / Hospice Care / Neoplasm Metastasis / Neoplasms Type of study: Incidence_studies / Prognostic_studies / Screening_studies Limits: Aged / Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: Cancer Epidemiol Biomarkers Prev Journal subject: BIOQUIMICA / EPIDEMIOLOGIA / NEOPLASIAS Year: 2015 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Indians, North American / Registries / Population Surveillance / Hospice Care / Neoplasm Metastasis / Neoplasms Type of study: Incidence_studies / Prognostic_studies / Screening_studies Limits: Aged / Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: Cancer Epidemiol Biomarkers Prev Journal subject: BIOQUIMICA / EPIDEMIOLOGIA / NEOPLASIAS Year: 2015 Document type: Article Country of publication: United States