Preferences for More Aggressive End-of-life Pharmacologic Care Among Racial Minorities in a Large Population-Based Cohort of Cancer Patients

CONTEXT

Minority patients receive more aggressive and potentially suboptimal care at the end of life (EOL). We investigated preferences about pharmacologic interventions at the EOL and their potential variation by sociodemographic factors among recently diagnosed cancer patients.

METHODS

A population-based cross-sectional survey of cancer patients identified through the Texas Cancer registry was conducted using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about potential pharmacologic interventions at the EOL were the focus of this investigation. Inverse probability weighted multivariate analysis examined associations of sociodemographic characteristics, health literacy, and trust in medical professionals with pharmacologic preferences.

RESULTS

Of the 1480 included responses, 13.3% stated they would take a medication that may prolong life at the cost of feeling worse. Adjusted analyses showed Black or Hispanic race/ethnicity, living with another person, and having a higher trust score were more likely to express this preference. In contrast, 41-65 years (vs. 21-40 years), living in a rural area, and adequate or unknown health literacy were less likely to express this preference. Overall 16% of respondents were opposed to potentially life shortening palliative drugs. In adjusted analysis Black or Hispanic respondents were more likely to be opposed to potentially life shortening drugs although age 65-79 and ≥college education were associated with a decreased likelihood of opposition to this item.

CONCLUSION

Black and Hispanic cancer patients were more likely to express preferences toward more aggressive EOL pharmacologic care. These findings were independent of other sociodemographic characteristics, health literacy and trust in the medical profession.

Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review

CONTEXT

There has been surprisingly little attention to conceptual and methodological issues that influence the measurement of discretionary utilization at the end of life (DIAL), an indicator of quality care.

OBJECTIVE

The objectives of this study were to examine how DIALs have been operationally defined and identify areas where evidence is biased or inadequate to inform practice.

METHODS

We conducted a scoping review of the English language literature published from 1/1/04 to 6/30/17. Articles were eligible if they reported data on ≥2 DIALs within 100 days of the deaths of adults aged ≥18 years. We explored the influence of research design on how researchers measure DIALs and whether they examine demographic correlates of DIALs. Other potential biases and influences were explored.

RESULTS

We extracted data from 254 articles published in 79 journals covering research conducted in 29 countries, mostly focused on cancer care (69.1%). More than 100 DIALs have been examined. Relatively crude, simple variables (e.g., intensive care unit admissions [56.9% of studies], chemotherapy [50.8%], palliative care [40.0%]) have been studied more frequently than complex variables (e.g., burdensome transitions; 7.3%). We found considerable variation in the assessment of DIALs, illustrating the role of research design, professional norms and disciplinary habit. Variables are typically chosen with little input from the public (including patients or caregivers) and clinicians. Fewer than half of the studies examined age (44.6%), gender (37.3%), race (26.5%), or socioeconomic (18.5%) correlates of DIALs.

CONCLUSION

Unwarranted variation in DIAL assessments raises difficult questions concerning how DIALs are defined, by whom, and why. We recommend several strategies for improving DIAL assessments. Improved metrics could be used by the public, patients, caregivers, clinicians, researchers, hospitals, health systems, payers, governments, and others to evaluate and improve end-of-life care.

Anti-ageing effects of red ginseng on female Drosophila melanogaster

Red ginseng (RG) was recently reported to extend the lifespan of Drosophila melanogaster. However, the mechanism underlying this effect has not yet been elucidated. The present study aimed to elucidate the molecular mechanisms of the RG‐mediated prolongation of the lifespan of female D melanogaster. In this study, protein changes in 36‐day‐old female D melanogaster were identified using isobaric tag for relative and absolute quantitation (iTRAQ), and levels of differentially expressed proteins were verified by quantitative real‐time PCR and Western blotting. Our studies have shown that RG concentrations of 12.5, 15 and 17.5 mg/mL significantly prolonged the lifespan. Eleven proteins were up‐regulated and 46 were down‐regulated between the RG and control groups; and Pebp1 expression was significantly down‐regulated. In addition, AKT and p‐AKT were down‐regulated, and ERK, p‐ERK and Raf1 were up‐regulated by RG. Therefore, RG significantly prolonged the lifespan of female D melanogaster by reducing the expression of Pebp1, up‐regulating ERK and inhibiting the AKT pathway. RG may be a potential drug for anti‐ageing treatment.