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A cancer patient’s race, type of insurance, and setting in which they are treated are all associated with end-of-life treatment, according to a study published in the Journal of Clinical Oncology.
The study showed that White patients, those with commercial insurance, and those treated in community practice settings were more likely to receive systemic cancer treatment at the end of life.
For this study, researchers examined data from the Flatiron Health electronic health record-derived database. The study included 53,791 patients who had been diagnosed with advanced or metastatic cancer, had received at least 1 line of cancer treatment, and died within 4 years of diagnosis. The researchers assessed the use of systemic therapy within 30 days before death and within 14 days before death.
White patients were significantly more likely than Black patients to have received systemic treatment within 30 days of death (36.6% and 32.7%, respectively; P <.001) and within 14 days of death (15.7% and 13.6%, respectively; P <.001).
Patients with commercial insurance were more likely than patients with Medicare or Medicaid to receive systemic treatment at the end of life. The proportion of patients who received systemic treatment within 30 days was 43.3% among those with private insurance, 37.3% among those with Medicare, and 37.0% among those with Medicaid (P <.001). The percentages of patients who received systemic treatment within 14 days were 18.6%, 15.6%, and 14.9%, respectively (P <.001).
Patients treated at community practices were more likely than those treated at academic practices to receive systemic treatment within 30 days (37% and 34%, respectively; P <.001). There was a numeric difference in systemic treatment within 14 days as well, but the difference was not statistically significant between community and academic practices (15.8% and 15.0%, respectively).
In multivariable analyses, White race and commercial insurance were significantly associated with receiving systemic treatment within 30 days or 14 days of death. Treatment at a community practice was significantly associated with receiving systemic treatment within 30 days of death but not within 14 days of death.
“Although our analysis can only report associations and not causality, this constellation of findings suggests that economics of cancer payment and structural differences in care delivery could be key factors,” the researchers concluded. “If indeed economic drivers, such as reimbursement for SACT [systemic anticancer therapy], are leading to overuse of high-cost targeted and immune therapies at the EOL [end of life], future care delivery models should look at changing payment incentives.”
Disclosures: This research was supported Flatiron Health, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Canavan M, Wang X, Ascha M, et al. End-of-Life systemic oncologic treatment in the immunotherapy era: The role of race, insurance, and practice setting. J Clin Oncol. Published online June 20, 2023. doi:10.1200/JCO.22.02180
