Cancer patients who are racial minorities, especially black Americans, are more willing than their white counterparts to exhaust personal financial resources to prolong life, according to a study published today in the journal Cancer.
In a study of 4,214 people recently diagnosed with lung or colorectal cancer, including some in California, researchers at the University of Alabama at Birmingham found that 80 percent of blacks were willing to spend all their personal finances to extend life, while 72 percent of Asians, 69 percent of Hispanics and 54 percent of whites were willing to do so.
"As new cancer-treatment options emerge, patients are asked to make complex decisions that often involve tradeoffs between quality and quantity of life," lead author Michelle Martin, an assistant professor at the university's Division of Preventive Medicine, said in a statement. "Our results highlight the fact that personal finances can influence the decisions patients make about their treatment."
Research has shown that minorities are more likely to want and receive more aggressive end-of-life care. A 2006 report by the California HealthCare Foundation found that 44 percent of the state's Latinos and African Americans, and 28 percent of Asians, believed doctors and nurses should do everything possible in all circumstances to save a patient, whereas only 14 percent of whites held this opinion.
Yet little is known about patients' willingness to spend personal finances to receive life-prolonging care, the study said.
Patients in the study were asked, "If you had to make a choice now, would you prefer treatment that extends life as much as possible, even if it means using all of your financial resources, or would you want treatment that costs you less, even if it means not living as long?"
After accounting for factors including income, education, sex, age, presence of a partner and dependents, disease stage, quality of life and perceived time left to live, blacks were 2.4 times more likely than whites to expend all financial resources to extend life. Asian and Hispanic patients were 1.59 and 1.45 times, respectively, more likely to spend all their resources than were white patients.
Whether a patient had health insurance had no statistical effect on the results by racial group, the study found. Other factors, however, were associated with a decreased willingness to exhaust finances to extend life.
Patients whose incomes supported three or more people were less wiling to expend all resources than those who supported just one person. Those who were married or living with a partner were also less willing than those who were divorced or separated.
Compared to people who said they did not know how much longer they'd live, patients expecting to live less than five years were less willing to spend their resources to extend life, and those believing their life expectancy was "in God's hands" were 1.53 times more willing.
The study does not explain the differences in treatment preferences, but it points to cultural beliefs as one reason blacks could be more willing to expend their finances to prolong life. Researchers said they hope their findings lay the groundwork for future studies.