Trends in Receipt of End-of-Life Systemic Treatment for Patients With Cancer

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In a U.S. study reported in the Journal of Clinical Oncology, Canavan et al found that White vs Black patients, patients with commercial insurance vs Medicare/Medicaid, and patients treated at community practices vs academic centers were more likely to receive end-of-life systemic therapy for advanced or metastatic cancer. 

Study Details

The study included data from patients in a real-world electronic health record–derived database (Flatiron Health) who received systemic therapy for advanced or metastatic cancer diagnosed starting in 2011 and who died between 2015 and 2019. The primary outcome was the use of any end-of-life systemic therapy within 30 days before death. End-of-life therapy was divided into chemotherapy alone, chemotherapy plus immunotherapy, and immunotherapy ± targeted therapy.

Key Findings

Among 57,791 patients from 150 practices included in the analysis, 19,837 (34.3%) received systemic treatment within 30 days of death, including 36.6% of White patients, 32.7% of Black patients, 43.3% of commercially insured patients, 37.3% of Medicare-insured patients, 37.0% of Medicaid-insured patients, 33.8% of patients at academic centers, and 37.2% of patients at community practices.

Black patients were less likely vs White patients to receive any end-of-life systemic treatment within 30 days (adjusted odds ratio [aOR] = 0.85, 95% confidence interval [CI] = 0.79–0.91); the finding was driven by reduced use of immunotherapy ± targeted therapy among Black patients (aOR = 0.86, 95% CI = 0.75–0.98).

Patients with Medicaid (aOR = 0.82, 95% CI = 0.73–0.93) and Medicare (aOR = 0.85, 95% CI = 0.78–0.92) were less like to receive any end-of-life systemic treatment vs those with commercial insurance. The difference for Medicaid vs commercial insurance was driven by reduced receipt of immunotherapy ± targeted therapy (aOR = 0.72, 95% CI = 0.57­–0.90).

Patients treated at academic centers were less likely to receive any end-of-life systemic treatment vs those at community practices (aOR = 0.66, 95% CI = 0.49–0.89).

The investigators concluded, “In a large real-world population, end-of-life systemic treatment rates were related to patient race, insurance type, and practice setting. Future work should examine factors that contribute to this usage pattern and its impact on downstream care.”

Kerin Adelson, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Flatiron Health Inc, an independent subsidiary of the Roche Group. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.