Journal Article

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States

Yerramilli, Divya, Jain, Bhav, Kohli, Mahi, Swami, Nishwant, Dee, Edward Christopher, Kohli, Khushi, Chino, Fumiko, Ranganathan, Sruthi, Iyengar, Puneeth

2024

Overview

Purpose Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. Methods We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004–2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. Results Among 775,289 individuals diagnosed with cancer (median age: 68 years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60–0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81–0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44–0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74–0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32–2.75], P = 0.001; Hawaiian AOR 2.09, [1.20–3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21–2.43], P = 0.001; Hawaiian AOR 1.70, [1.08–2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70–2.17], P < 0.001; Hawaiian AOR 2.95, [2.5–3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34–1.96], P < 0.001). Conclusions and relevance Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Analysis / Asian - statistics & numerical data / Asian Americans / Breast cancer / Breast Neoplasms - ethnology / Breast Neoplasms - pathology / Breast Neoplasms - therapy / Cancer / Cohort analysis / Cohort Studies / Descent / Female / Health aspects / Health care / Health services / Healthcare Disparities - ethnology / Healthcare Disparities - statistics & numerical data / Hmong people / Humans / Logistic Models / Lung cancer / Lung Neoplasms - ethnology / Lung Neoplasms - pathology / Lung Neoplasms - therapy / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Metastasis / Middle Aged / Native Hawaiian or Other Pacific Islander - statistics & numerical data / Neoplasm Metastasis / Neoplasms - ethnology / Neoplasms - pathology / Neoplasms - therapy / Nursing / Nursing Research / Oncology / Pacific Islander people / Pain Medicine / Palliative care / Palliative Care - statistics & numerical data / Palliative treatment / Patients / Philippino / Prostate / Prostate cancer / Prostatic Neoplasms - ethnology / Prostatic Neoplasms - pathology / Prostatic Neoplasms - therapy / Rehabilitation Medicine / Retrospective Studies / Southeast Asian cultural groups / United States