Clinical guidelines emphasize the importance of palliation and quality of life rather than aggressive end-of-life care for women who have advanced ovarian cancer. Using data from a Medicare-linked national database, researchers studied trends and racial disparities in end-of-life care for women who had ovarian cancer.

A total of 7,756 women who had ovarian cancer, were older than age 66, had enrolled in Medicare, and had died between 2007 and 2016 were included in the study sample.

The proportion of women who didn't enroll in hospice care declined over time. Among those who did enroll, the proportion enrolling late didn't improve. The median hospice length of stay didn't change significantly. The proportion of women dying in the hospital decreased, but the number admitted to the ICU increased, as did the proportion of women with more than one ED visit. Receipt of chemotherapy and life-extending procedures in the last two weeks of life remained stable over time.

There were notable racial disparities. Compared with non-Hispanic White women, non-Hispanic Black women were approximately twice as likely to have more than one ED visit or life-extending procedure. Women in the "other races" group were also twice as likely as non-Hispanic White women to have a terminal hospitalization and receive life-extending procedures.

The results may not be applicable to other populations, say the authors. They also note that they combined women with distinct races and ethnicities into the other races group owing to their small numbers and that a change in coding between revisions of the International Classification of Diseases may have affected the consistency of their measurements of aggressive treatment. A better understanding of what drives physician and patient decisions is needed to reduce the use of aggressive end-of-life care, the authors conclude.