Check Devon K, Samuel Cleo A, Rosenstein Donald L, Dusetzina Stacie B
All authors: University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Clin Oncol. 2016 Jul 1;34(19):2265-70. doi: 10.1200/JCO.2015.64.8162. Epub 2016 May 9.
Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care.
We used 2007 to 2012 SEER-Medicare data to evaluate use of supportive medications (opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids) in the 90 days postdiagnosis among black and white women with stage IV breast cancer who died between 2007 and 2012. We used modified Poisson regression to assess the relationship between race and supportive treatment use and end-of-life care (hospice, intensive care unit, more than one emergency department visit or hospitalization 30 days before death, in-hospital death).
The study included 752 white and 131 black women. We observed disparities in nonopioid psychotropic use between black and white women (adjusted risk ratio [aRR], 0.51; 95% CI, 0.35 to 0.74) but not in opioid pain medication use. There were also disparities in hospice use (aRR, 0.86; 95% CI, 0.74 to 0.99), intensive care unit admission or more than one emergency department visit or hospitalization 30 days before death (aRR, 1.28; 95% CI, 1.01 to 1.63), and risk of dying in the hospital (aRR, 1.59; 95% CI, 1.22 to 2.09). Supportive medication use did not attenuate end-of-life care disparities.
We observed racial disparities in early supportive medication use among patients with stage IV breast cancer. Although they did not clearly attenuate end-of-life care disparities, medication use disparities may be of concern if they point to disparities in adequacy of symptom management given the potential implications for quality of life.
早期支持性护理可能改善癌症患者的生活质量和临终关怀。我们评估了在早期使用治疗常见癌症症状（抑郁、焦虑、失眠）药物方面的种族差异，以及这些潜在差异是否会改变临终关怀。
我们使用2007年至2012年的监测、流行病学和最终结果（SEER）-医疗保险数据，评估2007年至2012年间死亡的IV期乳腺癌黑人与白人女性在确诊后90天内使用支持性药物（阿片类止痛药物和非阿片类精神药物，包括抗抑郁药/抗焦虑药和助眠药物）的情况。我们使用修正泊松回归来评估种族与支持性治疗使用以及临终关怀（临终关怀机构、重症监护病房、死亡前30天内多次急诊就诊或住院、院内死亡）之间的关系。
该研究纳入了752名白人女性和131名黑人女性。我们观察到黑人和白人女性在使用非阿片类精神药物方面存在差异（调整风险比[aRR]，0.51；95%置信区间[CI]，0.35至0.74），但在使用阿片类止痛药物方面没有差异。在临终关怀机构使用（aRR，0.86；95%CI，0.74至0.99）、重症监护病房入院或死亡前30天内多次急诊就诊或住院（aRR，1.28；95%CI，1.01至1.63）以及院内死亡风险（aRR，1.59；95%CI，1.22至2.09）方面也存在差异。支持性药物的使用并未减轻临终关怀方面的差异。
我们观察到IV期乳腺癌患者在早期使用支持性药物方面存在种族差异。尽管这些差异并未明显减轻临终关怀方面的差异，但鉴于对生活质量的潜在影响，如果药物使用差异表明症状管理的充分性存在差异，那么这些差异可能值得关注。
