Race, disparities, and end-of-life care for prostate cancer patients


A newly published paper in the Journal of the National Comprehensive Cancer Network has identified a series of significant disparities in there clinical care of African American men as opposed to Caucasians.

The paper by Abdollah et al. (and a related story by Bath on The ASCO Post web site) focus particularly on disparities related to end-of-life care. Specifically, the authors note that:

  • African American men with late-stage prostate cancer who are close to death tend to receive more aggressive treatments (in intensive care units and in hospitals) than comparable white patients.
  • Such aggressive treatment “may represent poor quality of care” compared to the care offered to white patients through hospice services and palliative at-home care.
  • The implementation of overly aggressive, high-intensity, end-of-life care in both African Americans and whites has decreased over the past decade (which is a good thing), but …
  • More terminally ill African American prostate cancer patients still receive such high-intensity, end-of-life care compared to otherwise similar white patients.
  • This disparity may — perhaps — be explained by such factors as
    • A lower level of willingness to accept palliative care and hospice care among black patients and their family members
    • Poor levels of physician-patient communication (especially between African American patients and non-African American physicians)
    • A lower level of awareness (or a complete lack of any awareness) about appropriate options for end-of-life care.

The authors also observed that African American patients nearing the end of life from metastatic prostate cancer appear to have fewer and less frequent office visits than comparable white patients — which may be associated with a lower level of access to good quality primary care among the African American community (for financial and other societal reasons).

Abdollah et al. conclude, bluntly, that:

Although diagnostic and therapeutic interventions are less frequent in black patients with end-stage [prostate cancer], the rate of high-intensity and aggressive [end-of-life] care is higher in these individuals. These disparities may indicate that race plays an important role in the quality of care for men with end-stage [prostate cancer].

Another key factor affecting this type of disparity is the decline in the numbers of African Americans who are seeking to become physicians over recent years. Unsurprisingly, for obvious socio-cultural reasons, many African Americans would rather receive care from an African American physician. The serious decrease in the number of African American physicians makes it increasingly difficult for African American patients to find clinicians in whom they feel they can place an appropriately high degree of trust. Even when they can find a black physician, it will often be the case that that physician is actually (for example) an Americanized Nigerian as opposed to a native-born African American. What is worse — from a prostate cancer point of view — is that the number of African American urologists and medical oncologists is truly tiny.

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