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Design and Participants: This retrospective cohort analysis used National Cancer Database data (2004-2018) to analyze disparities in PC receipt among disaggregated AA&NHPI patients with stage IV lung, breast, and prostate cancers. PC was any care provided to palliate/alleviate symptoms, including surgery, radiation therapy, systemic therapy (chemotherapy, hormone therapy, or other systemic drugs), and other pain management therapy. White vs AA&NHPI patients were compared as one cohort, as well as White vs disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. Multivariable logistic regressions were performed.
Results: Patients (N=775,289; 14% prostate, 13% breast, and 74% lung) were aged median 68 years (IQR=60-76). No PC receipt differences were observed between White patients and aggregated AA&NHPI patients with prostate, breast, or lung cancer. However, disaggregated analyses suggested reduced PC receipt for breast cancer patients of Asian Indian/Pakistani descent (adjusted odds ratio=0.75 [95% CI=0.60-0.94]) and for lung cancer patients of Chinese (0.88 [0.81-0.94]), Vietnamese (0.89 [0.80-0.99]), Thai (0.64 [0.44-0.92]), and Asian Indian/Pakistani (0.83 [0.74-0.93]) descent vs White patients. PC was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese 1.9 [1.3-2.8], Hawaiian 2.1 [1.2-3.7]), breast cancer (1.7 [1.2-2.4], 1.7 [1.1-2.7]), and lung cancer (1.9 [1.7-2.2], 3.0 [2.5-3.5]), as well as patients of Other Pacific Islander descent with lung cancer (1.6 [1.3-2.0]).
Commentary: AA&NHPI is an umbrella term comprising heterogenous racial/ethnic groups that are culturally and linguistically distinct, encompassing over 50 ethnicities and hundreds of languages. This study highlights the importance of disaggregation in health services research and not amassing groups together based on superficial appearances or proximal geographical origins. Analyzing the group as an aggregate resulted in the masking of disparities in PC receipt in AA&NHPI patients with cancer, thereby not addressing and potentially further perpetuating bias. Engaging with local community leaders and conducting focus groups with members of each community can be ways to better understand the complex interplay of culture, language, socioeconomics, and religion in patients with serious illness and those receiving end-of-life care within each subgroup.
Bottom Line: More research studying the barriers to PC faced by specific AA&NHPI subgroups is needed to better tailor interventions that address cultural, religious, linguistic, socioeconomic, and healthcare barriers unique to each group.
Reviewer: Mei-Ean Yeow, BMBCh FACP FAAHPM, Mayo Clinic, Rochester, MN
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