Requirement to forgo cancer treatment causes racial disparities in hospice use

Racial disparities in end of life cancer care may be caused by a preference for continuing aggressive treatment – a decision that blocks enrolment in hospice care – according to a study by Jessica Fishman, PhD and David J. Casarett, MD, MA, of the University of Pennsylvania School of Medicine and Veterans Affairs Center for Health Equity Research and Promotion, and colleagues.

In this study, African-Americans patients with cancer were less willing to give up treatment, compared with white patients. In addition, African-American patients reported greater needs for hospice services (i.e. counsellor, respite care, chaplain, nurse), despite the fact that their cancer treatment preferences would exclude them from most hospice programs.

The study, published early online last week by CANCER, a peer-reviewed journal of the American Cancer Society, indicates that the eligibility criteria for hospice services should be reconsidered.

"Hospice should not require patients to give up cancer treatment in order to enrol, because this prevents those patients with the greatest need from receiving hospice care,” said Dr. Casarett. “We should determine eligibility for hospice in the same way that we determine eligibility for other medical treatments and services: based on the patient’s need.”

(Source: CANCER: PENN Medicine: January 2009)