Provider-based research networks demonstrate greater hospice use for minority patients with lung cancer.
OBJECTIVE
The Community Clinical Oncology Program (CCOP) and Minority-Based Community Clinical Oncology Program (MBCCOP) are provider-based research networks (PBRN) that improve minority enrollment in cancer-focused clinical trials. We hypothesized that affiliation with a PBRN may also mitigate racial differences in hospice enrollment for patients with lung cancer.


METHODS
We used the SEER-Medicare data, linked to the National Cancer Institute's CCOP program data, to identify all patients (≥ age 65 years) with lung cancer, diagnosed from 2001 to 2007. We defined clinical treatment settings as CCOP, MBCCOP, academic, or community-affiliated and used multivariable logistic regression analysis to determine factors associated with hospice enrollment.


RESULTS
Forty-one thousand eight hundred eighty-five (55.1%) patients with lung cancer enrolled in hospice before death. Approximately 55% of CCOP, 57% of MBCCOP, 57% of academic, and 52% of community patients enrolled. Patients who were more likely to enroll were female (odds ratio [OR], 1.36; 95% CI, 1.31 to 1.40); ≥ age 79 years (OR, 1.11; 95%CI, 1.06 to 1.16); white; lived in more educated areas; had minimal comorbidities; and had distant disease. Asian and black patients in academic (41.1% and 50.4%, respectively) and community practices (35.2% and 43.4%, respectively) were less likely to enroll in hospice compared with white patients (academic, 58.8%; community, 53.1%). However, hospice enrollment was equivalent for black and white patients in MBCCOP (59.5% v 57.2%) and CCOP (52.2% v 56.3%) practices.


CONCLUSIONS
Minority patients with lung cancer receiving treatment in cancer-focused PBRN- affiliated practices have greater hospice enrollment than those treated in academic and community practices.
University of North Carolina School of Medicine; and University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel, Hill, NC dopenn@unch.unc.edu.
Dolly C
DC
Penn
University of North Carolina School of Medicine; and University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel, Hill, NC.
Karyn B
KB
Stitzenberg
University of North Carolina School of Medicine; and University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel, Hill, NC.
Ewan K
EK
Cobran
University of North Carolina School of Medicine; and University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel, Hill, NC.
Paul A
PA
Godley
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003153:Community Health Services; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data; D011320:Primary Health Care; D018426:SEER Program; D014481:United States