Race/Ethnicity and County-Level Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surgery
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ORIGINAL ARTICLE – HEALTH SERVICES RESEARCH AND GLOBAL ONCOLOGY
Race/Ethnicity and County-Level Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surgery Alizeh Abbas, MBBS, J. Madison Hyer, MS, and Timothy M. Pawlik, MD, MPH, MTS, PhD Department of Surgery, The Ohio State University Wexner Medical Center and the James Cancer Hospital, Columbus, OH
ABSTRACT Background. Integration of palliative care services into the surgical treatment plan is important for holistic patient care. We sought to examine the association between patient race/ethnicity and county-level vulnerability relative to patterns of hospice utilization. Patients and Methods. Medicare Standard Analytic Files were used to identify patients undergoing lung, esophageal, pancreatic, colon, or rectal cancer surgery between 2013 and 2017. Data were merged with the Centers for Disease Control and Prevention’s social vulnerability index (SVI). Logistic regression was utilized to identify factors associated with overall hospice utilization among deceased individuals. Results. A total of 54,256 Medicare beneficiaries underwent lung (n = 16,645, 30.7%), esophageal (n = 1427, 2.6%), pancreatic (n = 6183, 11.4%), colon (n = 26,827, 49.4%), or rectal (n = 3174, 5.9%) cancer resection. Median patient age was 76 years (IQR 71–82 years), and 28,887 patients (53.2%) were male; the majority of individuals were White (91.1%, n = 49,443), while a smaller subset was Black or Latino (racial/ethnic minority: n = 4813, 8.9%). Overall, 35,416 (65.3%) patients utilized hospice services prior to death. Median SVI was 52.8 [interquartile range (IQR) 30.3–71.2]. White patients were more likely to utilize hospice care compared with minority patients (OR 1.24, 95% CI 1.17–1.31, p \ 0.001). Unlike White patients, there was reduced odds of hospice utilization (OR 0.97, 95% CI 0.96–0.99) and early hospice
Ó Society of Surgical Oncology 2020 First Received: 20 August 2020 Accepted: 15 September 2020 J. Madison Hyer, MS e-mail: [email protected]
initiation (OR 0.94, 95% CI 0.91–0.97) as SVI increased among minority patients. Conclusions. Patients residing in counties with high social vulnerability were less likely to be enrolled in hospice care at the time of death, as well as be less likely to initiate hospice care early. The effects of increasing social vulnerability on hospice utilization were more profound among minority patients.
In 2020, an estimated 606,520 individuals will die from cancer in the USA.1 Among individuals who die from cancer, only one in three will utilize hospice care. A concerted effort, including the Statement on Principles of Palliative Care by the American College of Surgeons, has been made to encourage the integration of palliative care services into the surgical treatment plan.2 Despite this, utilization of hospice care among patients undergoing cancer surgery remains particularly low.3–6 Previous work has highlighted disparities in the utilization of end-of-life care among cancer patients relative to patient-level fa
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