Disparities Among Asian and Black Patients with Cancer in Receipt of Palliative Care in a Single Urban Academic...

Background: Research examining racial-ethnic disparities in palliative care (PC) receipt has produced mixed results. Objectives: To examine racial disparities in PC receipt with a large-scale study in a well-established outpatient cancer PC program. Design: We performed a multivariable analysis to test the association of race-ethnicity with PC receipt, adjusting for age, sex, stage, cancer, and insurance type. Exploratory analyses included association of race-ethnicity with reason for referral, functional status, and time to death. Setting/Subjects: Using a cancer registry in an urban academic medical center in the United States, we performed a retrospective cohort study of cancer decedents from May 2007 to December 2021. Results: Of 18,797 eligible patients, 7.9% (n = 1484) received PC. In adjusted analyses, compared with White patients, Asian patients had higher odds of PC receipt (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.21-1.66), but there were no significant differences for Latino/a or Black patients. Asian patients received PC significantly closer to death compared with White patients (9.6 vs. 12.08 months, p = 0.02). Compared with White patients, Black patients were more likely to be referred to PC for pain (OR, 1.81; 95% CI, 1.07-3.06). Conclusion: Asian patients had higher odds, yet a shorter duration of PC receipt, suggesting delayed referrals. Black patients were more likely to be referred to PC for pain. Development of structural changes to PC referrals and tailored pain interventions may help ensure more equitable PC access and care.