title: Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives.
abstract: BACKGROUND
  Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer.
  
  
  METHODS
  The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care.
  
  
  RESULTS
  AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83-1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61-0.99).
  
  
  CONCLUSIONS
  Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted.
  
  
  CONCLUSIONS
  Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.
authors.affiliation: University of Washington, Division of Oncology, Seattle, Washington. Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington. shiovitz@uw.edu.
authors.forename: Stacey
authors.initials: S
authors.lastname: Shiovitz
authors.affiliation: University of Washington, Department of Pharmacy, Seattle, Washington.
authors.forename: Aasthaa
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Burnett-Hartman
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington.
authors.forename: Andrew
authors.initials: A
authors.lastname: Karnopp
authors.affiliation: Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington.
authors.forename: Scott V
authors.initials: SV
authors.lastname: Adams
authors.affiliation: Northwest Portland Area Indian Health Board, Portland, Oregon.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.affiliation: University of Washington, Department of Pharmacy, Seattle, Washington. Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, Washington. University of Washington, Division of General Medicine, Seattle, Washington.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D000368:Aged; D000413:Alaska / Q000208:ethnology; D005260:Female; D017051:Hospice Care / Q000379:methods*; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D008297:Male; D009362:Neoplasm Metastasis / Q000628:therapy*; D009369:Neoplasms / Q000208:ethnology*; D011159:Population Surveillance; D012042:Registries; D014481:United States / Q000453:epidemiology