Have Advanced-Stage Disease?  Your Race May Determine If You Get Certain Supportive Care

"Black woman at higher risk than white woman"

Many people diagnosed with advanced-stage cancer have some level of pain -- from mild to severe and from short episodes to longer-lasting pain. Studies have found that 56% to 75% of people with advanced-stage disease report pain as a side effect.

Pain can affect your quality of life, your mood, your ability to function and move, your appetite, and your sleep. So it's important that pain be treated. Don't believe the common assumption that because cancer is a serious disease, some level of pain is to be expected and accepted.

Palliative, or supportive, care is a team-based approach in which a group of professionals -- including doctors, nurses, social workers, psychiatrists, dieticians, and chaplains -- focuses on relieving the pain, anxiety, and stress that cancer can cause. Palliative care doesn't fight cancer, but it does ease pain and improve quality of life in many situations.

Palliative care isn't the same as hospice care. Hospice care is reserved for people facing the end of life, usually within 6 months. Palliative care is for anyone who needs help dealing with the physical pain, stress, and anxiety a serious illness can cause. Still, many people in hospice receive palliative care.

Studies have found that treatment for breast cancer can vary by race. Black women are less likely than white women to:

  • have genetic testing for gene mutations linked to breast cancer
  • have Oncotype DX genomic testing to help determine the risk of cancer recurrence
  • be treated with Herceptin (chemical name: trastuzumab)

  • So researchers wanted to know if there were differences in the supportive, palliative medicines given to black and white women diagnosed with stage IV breast cancer. A study suggests that black women are less likely to receive antidepressants and sleep aids than white women. For instance: Other differences in care by race were: 1) Black women were 14% less likely to use hospice care than white women; 2) Black women were 60% more likely to die in the hospital than white women; 3) Black women were 30% more likely to have been admitted to an intensive care unit or have more than one hospitalization or emergency room visit in their last 30 days of life than white women.

    While this didn't seem to lessen the quality of their end-of-life care, it may mean that black women's symptoms aren't being well-managed. The research was published online on May 9, 2016 by the Journal of Clinical Oncology.

    "Although we did not find evidence of a relationship between supportive medications use and end-of-life care, disparities in supportive medication use are concerning as they could point to inadequate symptom management and reduced quality of life," said Devon Check, Ph.D., research fellow at the University of North Carolina Gillings School of Global Public Health in an interview. "Studies have found that early introduction of palliative or supportive care is tied to higher rates of hospice use and less intensive end-of-life care, both of which are markers of high-quality end-of-life care.

    "To our knowledge, ours is the first study to demonstrate disparities in the use of supportive care medications," she continued. "It is important for patients and providers to communicate about supportive care needs and preferences -- like the management of symptoms of anxiety, depression, insomnia, and pain -- to alleviate patient distress and suffering. In order to determine whether disparities in medication utilization indicate disparities in quality, future research should include data on patients' supportive care need and preferences surrounding medication use."

    You and your doctors need to be in agreement about the approach to your care. So it's also a good idea to regularly review your feelings and treatment goals with your medical team. You may want to alter your treatment plan depending on how you feel, your quality of life, family issues, and/or financial concerns. It's important to know that your treatment plan isn't written in stone. You can talk to your doctor about changing it at any time.

    SOURCE: Journal of Clinical Oncology, May 9, 2016. Synopsis and analysis by breastcancer.org.