An AP medical writer, Mike Stobb, wrote an interesting and unusual article about a survey that was conducted asking if people would be willing to spend everything they have on aggressive treatments that might prolong their life. The survey concluded that blacks and other minorities with cancer are more likely than whites to say they would spend everything to stay alive, no matter the nature of their condition.
Why this seems to be true is not clear, 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 become in certain instances.
According to the survey, 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.
Ellen McCarthy, a Harvard University researcher who has studied racial disparities in cancer care but was not involved in the new study said, “It is interesting just how far minority patients, particularly black patients, are willing to go to extend their life.”
The findings from this survey was published online Tuesday by the journal Cancer. The survey was based on telephone interviews 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.
Men with prostate cancer were not included in the survey, and it’s unknown if their attitudes would differ.
In reality, the final days under aggressive treatment can be grim. Patients often have tubes in the nose and down the throat and be unable to eat or talk. They may be in pain or barely coherent, despite this many individuals are still willing to extend their life, even at the cost of all their resources.
“Some think being alive under any circumstances is an absolute good, which suggests an under appreciation of the burdens and over appreciation 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 telephone interviewers 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?”
The interviewers never gave a description 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.
Despite the racial differences, people with spouses and children to support were generally less willing than single people to exhaust their financial resources for their own care. But even among these family people, blacks were the most willing to go for broke.
These same racial patterns 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.
Because of other well documented disparities, 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 is probably another factor that comes into play. 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.
Joel T Nowak, M.A., M.S.W.
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