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Disparities in place of death for patients with primary brain tumors and brain metastases in the USA

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Abstract

Purpose

Patients with primary or metastatic brain tumors often require intensive end-of-life care, for which place of death may serve as a quality metric. Death at home or hospice is considered a more “ideal” location. Comprehensive information on place of death of people with brain tumors is lacking.

Methods

Using CDC Wonder Database data, those who died in the USA from a solid cancer from 2003 to 2016 were included and place of death for those with primary brain, brain metastases, and solid non-brain tumors were compared. Multivariate logistic regression tested for disparities in place of death.

Results

By 2016, 51.1% of patients with primary brain tumors and 45.2% with brain metastases died at home. 15.9% of patients with primary brain tumors and 23.6% with brain metastases died in the hospital. Black patients were least likely to die at home or hospice. For patients with primary brain tumors, being married (OR = 2.25 (95%CI 2.16–2.34), p < 0.01) and having an advanced degree (OR = 1.204 (95%CI 1.15–1.26), p < 0.01) increased odds of home/hospice death; older age (OR = 0.50 (95%CI 0.46–0.54), p < 0.01) decreased odds for home/hospice death. For patients with brain metastases, being married (OR = 2.19 (95%CI 2.11–2.26), p < 0.01) increased odds of home/hospice death and male sex (OR = 0.87 (095%CI .85–0.89), p < 0.01) and older age (OR = 0.59 (95%CI 0.47–0.75), p < 0.01) decreased odds of home/hospice death.

Conclusion

Disparities exist in place of death in the brain tumor population. Focused interventions are indicated to increase the utilization of hospice in those with metastatic cancer, under-represented minority groups, and the elderly population.

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Data availability

Data is publicly available.

Code availability

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Author notes

    Authors and Affiliations

    1. Department of Radiation Oncology, Duke University School of Medicine, 20 Duke Medicine Cir, Durham, NC, 27710, USA

      Rachel F. Shenker & Junzo Chino

    2. Department of Interventional Radiology, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, NY, USA

      Mary Elizabeth McLaughlin

    3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

      Fumiko Chino

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    1. Rachel F. Shenker
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    Contributions

    Writing: RS and MEM. Editing: RS, MEM, FC, JC. Data analysis: RS, MEM, FC, JC. Concept: RS, MEM, FC, JC.

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    Correspondence to Rachel F. Shenker.

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    Shenker, R.F., Elizabeth McLaughlin, M., Chino, F. et al. Disparities in place of death for patients with primary brain tumors and brain metastases in the USA. Support Care Cancer 30, 6795–6805 (2022). https://doi.org/10.1007/s00520-022-07120-4

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