Abstract A031: High-intensity end-of-life care among young and middle-aged Hispanic adults with cancer living in Puerto Rico: A population-based study
Authors: Velazquez Jessica , Cassese Barbara , Tortolero-Luna Guillermo , Ramos-Fernández María R. , Castañeda-Avila Maira A. , Ortiz-Ortiz Karen J. 
Published: January 2023

Abstract
Background: High-intensity care with undue suffering at the end of life (EoL) among cancer patients is associated with poor quality of life (QoL). Timely palliative and hospice care along with advance care planning can reduce the use of potentially avoidable aggressive care and enhance the QoL of cancer patients nearing death by providing pain and symptom management. We described the patterns of care at EoL and evaluated the predictors of intensive care among Hispanic cancer patients. Methods: We used data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database to examine patients aged 18 to 64 years diagnosed with cancer between 2010 and 2019, with a recorded date of death, who died of cancer between 2017 and 2019, and who were enrolled in Medicaid or private insurance 30 days before death (N=1,637). High-intensity EoL care indicators included the following services in the 30 days before death: ≥2 emergency room (ER) visits, &gt;1 hospitalization, ≥1 intensive care unit (ICU) admission, and ≥1 life-extending procedure. A logistic regression model was used to examine factors associated with high-intensity EoL care. Results: More than half of the patients were 55 to 64 years old (58.7%), 52.9% were female, and 83.1% were enrolled in Medicaid. Most of the patients had solid tumors (91.0%) and 51.1% survived ≤12 months after diagnosis. More than half of the patients had at least one ER visit (54.2%) and nearly three-fourths had at least one hospitalization (73.7%). In addition, 28.2% of patients had ≥2 ER visits, 25.8% had &gt;1 hospitalization, 11.3% were in the ICU, and 13.7% received life-extending procedures. A compound indicator of high-intensity care at EoL showed that 53.0% of patients had at least one of the selected high-intensity indicators, whereas a compound indicator of recommended care at EoL showed that only 29.6% of patients had at least one of the selected recommended care indicators, which included hospice and palliative care and advance care planning. Patients without recommended care at EoL were more likely to receive high-intensity EoL care than patients with recommended care at EoL (adjusted odds ratio 2.53; 95% confidence interval 2.02 – 3.16). High-intensity EoL care was more likely in patients with hematologic cancers than those with solid tumors (P=0.009), patients who survived ≤12 months after diagnosis compared to those who survived &gt;12 months (P&lt;0.001), and patients 18 to 44 years old compared to those 55 to 64 years old (P=0.023). Conclusion: These findings suggest that a higher proportion of Hispanic cancer patients living in Puerto Rico have unmet palliative care needs and potentially lower QoL at EoL. Recommended care can provide prompt pain and symptom management, reduce emotional distress, ensure medical care consistent with individual preferences, and reduce the cost of medical care by eliminating treatments and procedures that may have no or low benefit. Future research evaluating strategies to improve the use of hospice, palliative consultation, and advance care planning is needed.
Citation Format: Jessica Velazquez, Barbara Cassese, Guillermo Tortolero-Luna, María R. Ramos-Fernández, Maira A. Castañeda-Avila, Karen J. Ortiz-Ortiz. High-intensity end-of-life care among young and middle-aged Hispanic adults with cancer living in Puerto Rico: A population-based study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A031.