Pediatr Blood Cancer 2014;61:1144
LETTER TO THE EDITOR Racial and Ethnic Differences in Hospice Enrollment Among Children with Cancer
To the Editor: While many factors affect health care equity, disparities based on race/ethnicity are consistently reported in the management of many acute and chronic diseases. Aside from cultural and religious factors, ethnic/interracial differences have been identified as major players in overall perceptions of the medical system that may greatly affect discussions and decisions related to end of life care hospice utilization, and the exercise of autonomy in medical decision-making [1]. Thienprayoon et al. showed higher rates of hospice enrollment amongst Latinos. However, other factors like stage of the disease at diagnosis could conceivably play a role here. Given the existing disparities in health care, certain ethnicities/races are at higher risk for diagnosis in advanced stages. Further valuable insight could be obtained if a sub group analysis could be done looking at associations that may exist with the disease stage, new diagnosis versus recurrent, relapsed disease. The results may have been largely influenced by the number of Hispanic subjects (44%) compared to the previous published single center study that has shown that race/ethnicity does not play a significant role in discussion of end of life care in children with oncological diagnosis [2]. Disparities in health care owing to race/ethnicity, minority group are so closely linked to socio-economic status; it is commendable that the payor status was well adjusted in this cohort. Families of children with brain tumors and solid tumors are more likely to be receptive to end of life discussions and hospice care owing to poorer prognosis compared to leukemias. Also, significant clinical events related to therapy or disease may spark end of life care discussions with the families when aggressive treatment could not be continued further.
The two strikingly important strengths of this report are utilization of the hospice data base and primary oncologist as the referring physician. Though oncological care in majority of centers is akin to group practice model, the families share a very sensitive bond with the primary oncology provider and are thus likely to be more receptive to end of life discussions from them [3]. Of note, Bhatia’s review shows poorer overall outcomes in blacks and Hispanics likely due to a combination of differences in disease biology, pharmacogenetics, socioeconomic, and sociocultural factors that influence health care access and adherence to management. However, a great amount of work still needs to be done to specifically identify communication barriers, disparities by cancer diagnoses across different minority groups and outcomes with treatment [4]. Preethi Reddy Marri, MD* Vilmarie Rodriguez, MD Division of Pediatric Hematology Oncology Department of Pediatrics Mayo Clinic Rochester, Minnesota
REFERENCES 1. Klopfenstein KJ, Hutchison C, Clark C, et al. Variables influencing end-of-life care in children and adolescents with cancer. J Pediatr Hematol Oncol 2001;23:481–486. 2. Baker JN, Rai S, Liu W, et al. Race does not influence do-not-resuscitate status or the number or timing of end-of-life care discussions at a pediatric oncology referral center. J Palliat Med 2009;12:71–76. 3. Johnston DL, Vadeboncoeur C. Palliative care consultation in pediatric oncology. Support Care Cancer 2012;20:799–803. 4. Bhatia S. Disparities in cancer outcomes: Lessons learned from children with cancer. Pediatr Blood Cancer 2011;56:994–1002.
Correspondence to: Preethi Reddy Marri, Division of Pediatric Hematology-Oncology, Mayo Clinic, 200 First St SW, Rochester, Minnesota 55905. E-mail: [email protected] Received 29 November 2013; Accepted 3 December 2013
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2013 Wiley Periodicals, Inc. DOI 10.1002/pbc.24914 Published online 27 December 2013 in Wiley Online Library (wileyonlinelibrary.com).
LETTER TO THE EDITOR Racial and Ethnic Differences in Hospice Enrollment Among Children with Cancer
To the Editor: While many factors affect health care equity, disparities based on race/ethnicity are consistently reported in the management of many acute and chronic diseases. Aside from cultural and religious factors, ethnic/interracial differences have been identified as major players in overall perceptions of the medical system that may greatly affect discussions and decisions related to end of life care hospice utilization, and the exercise of autonomy in medical decision-making [1]. Thienprayoon et al. showed higher rates of hospice enrollment amongst Latinos. However, other factors like stage of the disease at diagnosis could conceivably play a role here. Given the existing disparities in health care, certain ethnicities/races are at higher risk for diagnosis in advanced stages. Further valuable insight could be obtained if a sub group analysis could be done looking at associations that may exist with the disease stage, new diagnosis versus recurrent, relapsed disease. The results may have been largely influenced by the number of Hispanic subjects (44%) compared to the previous published single center study that has shown that race/ethnicity does not play a significant role in discussion of end of life care in children with oncological diagnosis [2]. Disparities in health care owing to race/ethnicity, minority group are so closely linked to socio-economic status; it is commendable that the payor status was well adjusted in this cohort. Families of children with brain tumors and solid tumors are more likely to be receptive to end of life discussions and hospice care owing to poorer prognosis compared to leukemias. Also, significant clinical events related to therapy or disease may spark end of life care discussions with the families when aggressive treatment could not be continued further.
The two strikingly important strengths of this report are utilization of the hospice data base and primary oncologist as the referring physician. Though oncological care in majority of centers is akin to group practice model, the families share a very sensitive bond with the primary oncology provider and are thus likely to be more receptive to end of life discussions from them [3]. Of note, Bhatia’s review shows poorer overall outcomes in blacks and Hispanics likely due to a combination of differences in disease biology, pharmacogenetics, socioeconomic, and sociocultural factors that influence health care access and adherence to management. However, a great amount of work still needs to be done to specifically identify communication barriers, disparities by cancer diagnoses across different minority groups and outcomes with treatment [4]. Preethi Reddy Marri, MD* Vilmarie Rodriguez, MD Division of Pediatric Hematology Oncology Department of Pediatrics Mayo Clinic Rochester, Minnesota
REFERENCES 1. Klopfenstein KJ, Hutchison C, Clark C, et al. Variables influencing end-of-life care in children and adolescents with cancer. J Pediatr Hematol Oncol 2001;23:481–486. 2. Baker JN, Rai S, Liu W, et al. Race does not influence do-not-resuscitate status or the number or timing of end-of-life care discussions at a pediatric oncology referral center. J Palliat Med 2009;12:71–76. 3. Johnston DL, Vadeboncoeur C. Palliative care consultation in pediatric oncology. Support Care Cancer 2012;20:799–803. 4. Bhatia S. Disparities in cancer outcomes: Lessons learned from children with cancer. Pediatr Blood Cancer 2011;56:994–1002.
Correspondence to: Preethi Reddy Marri, Division of Pediatric Hematology-Oncology, Mayo Clinic, 200 First St SW, Rochester, Minnesota 55905. E-mail: [email protected] Received 29 November 2013; Accepted 3 December 2013
C
2013 Wiley Periodicals, Inc. DOI 10.1002/pbc.24914 Published online 27 December 2013 in Wiley Online Library (wileyonlinelibrary.com).
