Race, Insurance, and Practice Setting Influence Aggressiveness of End-of-Life Care

November 22, 2023 by Elisa Becze BA, ELS, Editor

White patients with commercial insurance receiving care in a community setting are most likely to receive systemic anticancer therapy at the end of life, researchers reported in study findings published (https://doi.org/10.1200/jco.22.02180) in the Journal of Clinical Oncology.

Using a real-world electronic health record–derived deidentified database, the researchers analyzed 53,791 patients from 150 practices who received systemic therapy for advanced or metastatic cancer diagnosed in 2011 and died within four years from 2015–2019. Of those, 19,837 received systemic treatment within 30 days of death: 36.6% of White patients, 32.7% of Black patients, 43.3% of commercially insured patients, and 37.0% of Medicaid patients.

“Receipt of antineoplastic systemic treatment near end of life has been shown to harm patient and caregiver experience; increase hospitalizations, intensive care unit, and emergency department use; and drive up costs,” the researchers wrote.

“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,” they concluded. “Future work should examine factors that contribute to this usage pattern and its impact on downstream care.”

Watch a synopsis of the study findings below.

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