Chemotherapy at the End of Life in Colon Cancer Patients

Background Chemotherapy at the end of life may not extend survival and can diminish quality of life. Understanding patterns of use is critical to ensuring equitable, patient-centered care. Objective To examine racial and ethnic disparities in chemotherapy receipt within 30 days of death among patients with colon cancer, and whether these disparities changed over time. Design We conducted a retrospective cohort study using the National Cancer Database, identifying patients with colon cancer who died within 30 days between 2004 and 2021. The final sample included 43 490 patients. The primary outcome was chemotherapy receipt within 30 days of death. Multivariable logistic regression adjusted for demographics, insurance, comorbidities, facility characteristics, and socioeconomic factors. A difference-in-differences approach compared 2 periods: 2004-2012 and 2013-2021. Results Among 43 490 patients (mean age, 75.6 years; 51.1% female), 1275 (2.9%) received chemotherapy near death. Adjusted analyses found no statistically significant racial or ethnic differences in use. However, Asian American patients had a marginally increased likelihood of receiving chemotherapy over time compared with non-Hispanic White patients (interaction OR, 2.25; 95% CI, 0.95-5.32; P = .065). Older age (≥80 years: OR, 0.12), higher comorbidity burden (Charlson-Deyo score ≥2: OR, 0.61), and uninsured status were associated with lower odds of treatment. Private insurance (OR, 1.67) and treatment at comprehensive cancer centers were associated with higher odds. Conclusion While overt racial disparities were not observed, disparities by insurance and facility type point to structural inequities that should be addressed in future quality improvement efforts.