Patients with cancer nearing end of their lives ‘face inequalities in care’

Patients with cancer nearing the end of their lives are facing stark inequalities in care, a study suggests.

Researchers found that many cancer patients from black, South Asian, mixed and other ethnic backgrounds are living with pain as they are not given the same pain relief treatments as their white peers.

And this group are far more likely to end up in A&E in their final days and weeks compared with those given the pain relief, experts found.

Researchers from Hull York Medical School at the University of Hull, along with colleagues from King’s College London and Cambridge University, examined data on more than 230,000 adults diagnosed with cancer in England between 2011 and 2021.

They examined prescriptions of morphine, emergency department visits and hospital admissions in the last three months of life.

Their study, published in the British Journal of Cancer, found that prescription rates were highest among white patients.

And prescription rates were “significantly lower” among black, South Asian, mixed and other ethnic groups, the research team reported.

Meanwhile patients from minority ethnic backgrounds, particularly people of black and South Asian heritage, were more likely to visit an emergency department two or more times in the last three months of life.

They were also more likely to have two or more hospital admissions, according to the study.

“We discovered a number of interesting and inconvenient truths,” said lead researcher Jonathan Koffman, professor of palliative care and associate director at the Wolfson Palliative Care Research Centre.

Prof Koffman told the PA news agency: “The rates of prescriptions for opioids for those from minority ethnic populations compared to the white British population were much less, significantly less.

“We also discovered that the amount of morphine prescribed in those fewer prescriptions was commensurately less as well.”

On A&E visits, he said: “We can’t demonstrate causation, but there were higher rates of ED (emergency department) attendance amongst the same population who were receiving fewer prescriptions for their pain.

“So it’s possible that, as a consequence of pain being inadequately assessed and inadequately managed in the community, those patients from minority ethnic communities are having to seek treatment for their pain in ED departments.

“This is in the last three months of life, these are not places that people would want to be in by choice – we know how A&E is so stretched at the moment and waiting around to have your pain managed, that critical moment in patients’ and their families’ lives when they would prefer to be at home, seems intuitively unreasonable.”

Prof Koffman added: “We could save money for the NHS by managing it better in primary care.”

He said there are many possible drivers behind the findings, including patient preference and potential “implicit bias” from clinicians.

Prof Koffman said that cancer pain education resources which are culturally and ethnically tailored could help to empower patients.

He went on: “These findings underline the urgent need to understand and address inequities in pain relief and end-of-life care, ensuring that all patients receive appropriate and compassionate support regardless of ethnicity.

“Pain control at the end of life is not optional – it is a cornerstone of compassionate, high-quality care.

“To know that some groups of patients consistently receive less pain relief is both ethically indefensible and deeply concerning for health equity.”

Commenting on the study, Anthony Cunliffe, national lead medical adviser at Macmillan Cancer Support, said: “Today’s findings are deeply concerning.

“Pain control is the cornerstone of compassionate care, and no-one should be left without appropriate pain relief at the end of life.

“The publication of this data is a vital step forward in understanding where the gaps exist to ensure everyone, whatever their background, receives the best care possible.

“If you or a family member is receiving end of life care, Macmillan is here for you, whatever you need.

“If you have a question or simply need someone to talk to, our Support Line is open seven days a week (8am-8pm) and we also have practical and emotional advice on our website.”