Trends in Preferred Place of Death For Prostate Cancer in the United States from 2003 to 2020: Analysis of CDC WONDER Database

Document Type

Conference Proceeding

Publication Date

2-1-2024

Publication Title

Journal of Clinical Oncology

Abstract

Background: Prostate Cancer (PCa) is the most common cancer in men and the second cause of cancer mortality. The identification of the preferred place of death (PPOD) has been shown to improve the delivery of palliative care, reduce healthcare costs, and improve quality of care. We evaluated the trends in PPOD for patients and hospice utilization with PCa in the USA from 2003 to 2020 based on the CDC WONDER (Centers for Disease Control and Prevention for Wideranging Online Data for Epidemiologic Research) database. Methods: The US nationwide and state-level data was pooled using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data trends of PPOD for prostate cancer were pooled using the International Classification of Diseases, Tenth Revision as C61: malignant neoplasm of prostate. The analysis of trends in mortality over the past decade was stratified according to age, census region, race, and place of death. Results: The analysis demonstrated that overall mortality due to PCa was 526,783 from 2003 to 2020. Of these deaths, 43,813 (8.32%) were recorded in hospice facilities. The hospice mortality steadily increased from 0.4% in 2003 to the highest of 9.20% in 2019, with a notable decline to 7.6% in 2020. We noticed that the PPOD differed based on racial subgroups. More than half of mortality in the Native American (NA) and African-American (AA) subgroups was observed in a medical facility (51.81% and 58.21%, respectively) compared to Whites (49.15%). Hospice or death at home in NA and AA groups were (48.11% and 41.11%, respectively) compared to Whites (50.85%). The age-stratified mortality analysis revealed increased hospice utilization in 25-44 years (11.95%) vs. 65+ years (8.13%). Upon stratifying the results by census showed the highest hospice utilization in Florida, compared to the lowest in North Dakota (22.6% vs. 0.02%). Conclusions: To our knowledge, this is the first study utilizing the CDC WONDER database to analyze PPOD in PCa-related deaths. We observed a steady increase in hospice utilization from 2003 to 2019 throughout the US, with a decline in 2020, possibly due to the COVID-19 pandemic. The AA and NA groups had higher mortality in medical facilities compared to Whites, whereas the White population utilized more hospice services or died at home. This highlights the existing disparities in end-of-life care in PCa and promotes policy-level changes in the states with lower utilization of hospice services to improve access of care in PCa patients.

Volume

42

Issue

4 Suppl

First Page

231

Comments

2024 ASCO (American Society of Clinical Oncology) Genitourinary Cancers Symposium, January 25-27, San Francisco, CA

DOI

10.1200/JCO.2024.42.4_suppl.231

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