Blacks more willing to spend all for cancer care
ATLANTA — Blacks and other minorities with cancer are more likely than whites to say they would spend everything they have on aggressive treatments that might prolong their lives, a study found.
Researchers don’t know why this is so and didn’t ask, but some think it may reflect differences in beliefs about miracles, distrust of doctors among minorities and a misunderstanding of just how ugly and painful end-of-life care can be.
About 80 percent of blacks said they were willing to use up all their money to extend their lives, compared with 72 percent of Asians, 69 percent of Hispanics and 54 percent of whites.
“It is interesting just how far minority patients, particularly black patients, are willing to go to extend their life,” said Ellen McCarthy, a Harvard University researcher who has studied racial disparities in cancer care but was not involved in the new study.
The findings, published online last week by the journal Cancer, were based on telephone surveys of more than 4,100 people newly diagnosed with lung and colon cancer. About 17 percent of the colon cancer patients and 31 percent of the lung cancer patients were in the most advanced stages of their disease.
Those two cancers were chosen because they are common and deadly when diagnosed in late stages. Patients with breast or prostate cancer — the most common types in women and men, respectively — were not included, and it’s unknown if their attitudes would differ.
The cost of cancer care has soared in recent years, with many treatments priced at $100,000 or more sometimes adding only a few months of life.
Final days under aggressive treatment can be grim. Patients might have tubes in the nose and down the throat and be unable to eat or talk. They may be in pain or barely coherent.
“Some think being alive under any circumstances is an absolute good, which suggests an underappreciation of the burdens and overappreciation of the benefits of life-prolonging care,” said Holly Prigerson, another Harvard researcher who heads a Dana-Farber Cancer Institute center that studies social and psychological influences on cancer care.
The study asked: Would you want treatment that extended your life as long as possible, even if it caused you to go broke? Or would you opt for less expensive treatment that did not keep you alive as long?
Researchers gave no examples of what aggressive care could involve — surgery or chemotherapy, for instance — and did not specify how much longer the patient might live.
The results revealed racial differences even when other factors were taken into account.
For example, people with spouses and children to support were generally less willing than single people to exhaust their financial resources for their own care. But among these family people, blacks were the most willing to go for broke.
The same racial pattern held regardless of how sick patients were, their income and savings, age, time since diagnosis and how long they thought they had left to live.
“It was surprising,” said lead author Michelle Martin of the University of Alabama-Birmingham.
The study found blacks more often had a “try it” attitude. That seems to contradict previous studies that have indicated blacks have a greater distrust of the medical system.
But distrust could still be a factor. Perhaps a higher proportion of minorities worry that doctors might withhold care from them, and so they might be seeking the most aggressive options available, McCarthy said.
Minorities tend to be diagnosed at later stages of cancer than whites. At least one study of patients with advanced cancer found that blacks who wanted intensive end-of-life of care were less likely to receive it than whites with the same preference.
Faith may be another factor. The study did not assess how religious the participants were, but other studies have found that very devout people tend to want and get life-prolonging treatment, Prigerson said.
“Many religious patients assert, ‘There’s a higher authority than my doctors. God, not my doctors, decides whether it’s my time or not.’ Such patients believe it is a demonstration of their faith to hold onto life as long as possible to await the granting of a miraculous cure,” she said.