Race, Ethnicity, and Cancer Type Influence Which Patients Access Hospice Care

Use of hospice services by patients with cancer has increased over time; however, hospice care is still underutilized in general and specifically among patients of minority groups, according to a study in the Clinical Journal of Oncology Nursing. 

Although palliative care and hospice care are referred to interchangeably, they have distinct differences. The goal of palliative care is to provide patients with symptom relief throughout active cancer treatment and survival, whereas hospice care is provided to patients when curative treatment is no longer a goal. These patients are usually at the end of life, with an expected survival of less than 6 months.

Hospice care can significantly improve patient comfort at the end of life, but its use may not be widespread among patients. Therefore, a researcher from a comprehensive cancer center in North Carolina conducted a clinical literature review to investigate research outcomes of hospice use in the United States. They also sought to learn more about the differences in hospice use among various subsets of patients with cancer. 

A total of 17 quantitative studies, published between 2017 and 2023, was included in this review. 

Notable differences by cancer type were found. For example, patients with breast and colorectal cancers were less likely to use hospice care, and patients with hematologic cancers tended to experience more aggressive symptoms than those with solid tumors. Patients with acute leukemia were more likely to experience acute bleeding and sepsis at the end of life, which often resulted in their death occurring in a critical care setting. 

The analysis also showed disparities in hospice use by race and ethnicity. For example, patients who were Asian, Black, or Hispanic were less likely than White patients to use hospice services, as were patients from those minority groups who spoke English as a second language. Members of minority groups were also more likely to unenroll from hospice care. One study also noted that “despite increases in hospice enrollment, the relative disparity between White and Black patients grew over time.”

Additionally, patients in rural areas seemed less likely to enroll in or access hospice services. 

However, some studies did not report differences between hospice use and race and ethnicity. But even when controlling for those variables, hospice care was generally underutilized.  

In conclusion, patients with certain types of cancer are not using hospice services and hospice use is not equitable among patients from minority groups. 

“Based on the findings from this review, oncology nurses can advocate for all patients to receive hospice services to ensure quality end-of-life care, as well as improve their practice via professional development focused on hospice and end-of-life care for patients,” the researcher wrote.